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1
Block, Corey, Kim Bulkeley, and Michelle Lincoln. "Occupational Therapy with Australian Indigenous children and their families: A rural and remote perspective." Thesis, Discipline of Occupational Therapy, 2016. http://hdl.handle.net/2123/14325.
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Background/aim: Occupational therapy service delivery must be adapted when working with Indigenous communities, as there is a diversity of beliefs, values and customs. There are currently no evidence-based models of therapy service delivery to rural and remote Indigenous children and their families. This study aims to explore occupational therapy service delivery to rural and remote Indigenous children and their families. Methods: Semi-structured telephone interviews were conducted with seven occupational therapists with experience with Australian rural and remote Indigenous children and their families. A thematic analysis was conducted on each interview with constant comparison to refine themes across interviews. Results: A total of six service delivery themes emerged from the data gathered in the interviews; flexible and accessible services; tailored services; culturally sensitive therapist; culturally inclusive services; occupational therapy awareness; and collaboration. These results linked with the need for long-term solutions, as the limited access to occupational therapy within these communities is a social injustice. Conclusion: The findings demonstrate that each Indigenous community is unique. Therapists work in collaboration with the community and use their critical reasoning skills to adjust practice accordingly. Significance of the study: This study contributes to growing knowledge about occupational therapy service provision in rural and remote Indigenous communities with children and their families. The findings will assist therapist in these communities to provide culturally aligned services. They also advocate for these communities by emphasising the basic human right violations that Indigenous communities are experiencing by not having access to consistent and culturally appropriate occupational therapy services.
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Winroth, AnnCristin. "Boteberättelser : en etnologisk studie av boteprocesser och det omprövande patientskapet /." Umeå : Institutionen för kultur och medier, Umeå universitet, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-360.
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Ojelade, Ifetayo Iyajoke. "Use of Indigenous African Healing Practices as a Mental Health Intervention." Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/cps_diss/36.
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The purpose of this qualitative study was to describe the ways in which Orìsà priests and their clients conceptualize issues and concerns described by Western based approaches as mental health problems. The two research questions guiding this inquiry included: (a) how do Orìsà priests and their clients conceptualize issues and concerns associated with mental health problems in Western psychology and (b) what methods and techniques do Orìsà priests and their clients use to address issues or concerns associated with mental health problems in Western psychology? This study was grounded in African-centered theory by providing a cultural lens to guide the research design, data collection, and analysis. Data were collected during semi-structured individual interviews with four Orisa priests in a three phase model, for a total of 12 interviews. The study also included three focus groups (six informants per group), who did not participate in the individual interviews. Each group met for two sessions, for a total of six focus groups. Bracketing of assumptions by research team members and use of a reflexive journal was used to ensure credibility and dependability of the data (Creswell, 1998). Data analysis consisted of a recursive process divided into multiple steps, to help strengthen methodological rigor and verification of study procedures. The three part process included codebook development, code application, and data analysis. Three major themes emerged from the data. The first theme, The Conceptualization of Mental Health Problems as Spiritual Matters included one subtheme, Transgenerational Transmission. The second theme, Origins of Mental Health Problems, included three subthemes (Western Socialization, Spiritual Forces, and Ifa as a Healing System). The final theme, Addressing Mental Health Problems, included three subthemes (The Divination Process, Referrals, and Western Therapy). Results of this study indicate that respondents primarily conceptualize mental health problems as spiritual matters and seek to address these problems with the help of an Orìsà priest. In addition, some respondents sought the services of a Western trained therapist for the same issue. Practice and research implications are discussed.
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Jackson, Pulver Lisa Rae. "An argument on culture safety in health service delivery: towards better health outcomes for Aboriginal peoples." Thesis, The University of Sydney, 2003. http://hdl.handle.net/2123/609.
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The bureaucratic measure of health service, health performance indicators, suggest that we are not effective in our legislative responsibility to deliver suitable health care to some of the populations we are meant to serve. Debate has raged over the years as to the reasons for this, with no credible explanation accepted by those considered stakeholders. One thing is clear though, we have gone from being a culture believing that the needs of the many far outweigh those of the few, to one where we are barely serving the needs of the 'any'. This is most evident in the care delivered to the Aboriginal and Torres Strait Islander people of Australia.
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Best, Odette Michel, and n/a. "Community Control Theory and Practice: a Case Study of the Brisbane Aboriginal and Islander Community Health Service." Griffith University. School of Arts, Media and Culture, 2004. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20060529.144246.
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It is accepted protocol among Indigenous communities to identify one's link to land. I was born and raised in Brisbane. My birth grandmother is a Goreng Goreng woman, my birth grandfather is a Punthamara man. However, I was adopted by a Koombumberri man and an anglo-celtic mother after being removed at birth under the Queensland government policy of the day. The action of my removal and placement has had profound effects upon my growing and my place within my community today. For the last 15 years I have worked in the health sector. My current position is as a Lecturer within the Department of Nursing, Faculty of Science, University of Southern Queensland, Toowoomba. My areas of expertise are Indigenous Health and Primary Health Care. I have been employed in this capacity since January 2000. Prior to my full time employment as a nursing academic I have primarily been located within three areas of health which have directly impacted upon my current research. I was first positioned within health by undertaking my General Nurse Certificate through hospital-based training commenced in the late 1980s. For me this training meant being immersed within whiteness and specifically the white medical model. This meant learning a set of skills in a large institutionalised health care service with the provision of doctors, nurses, and allied medical staff through a hospital. Within this training there was no Indigenous health curriculum. The lectures provided on 'differing cultures' and health were on Muslim and Hindu beliefs about death. At that point I was painfully aware of the glaring omission of any representation of Indigenous health and of acknowledgment of the current outstanding health differentials between Indigenous and non-Indigenous Australians. I knew that the colonisation process inflicted upon Indigenous Australians was one of devastation. The decline in our health status at the time of colonisation had been felt immediately. Since this time our health has been in decline. While in the 1980s it was now no longer acceptable to shoot us, poison our waterholes, and incarcerate us on missions, we were still experiencing the influence of the colonisation process, which had strong repercussions for our current health status. Our communities were and remain rife with substance abuse, violence, unemployment, and much more. For Indigenous Australians these factors cannot be separated from our initial experience of the colonisation process but are seen as the continuation of it. However, there was no representation of this and I received my first health qualification.
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Best, Odette Michel. "Community Control Theory and Practice: a Case Study of the Brisbane Aboriginal and Islander Community Health Service." Thesis, Griffith University, 2004. http://hdl.handle.net/10072/366110.
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It is accepted protocol among Indigenous communities to identify one's link to land. I was born and raised in Brisbane. My birth grandmother is a Goreng Goreng woman, my birth grandfather is a Punthamara man. However, I was adopted by a Koombumberri man and an anglo-celtic mother after being removed at birth under the Queensland government policy of the day. The action of my removal and placement has had profound effects upon my growing and my place within my community today. For the last 15 years I have worked in the health sector. My current position is as a Lecturer within the Department of Nursing, Faculty of Science, University of Southern Queensland, Toowoomba. My areas of expertise are Indigenous Health and Primary Health Care. I have been employed in this capacity since January 2000. Prior to my full time employment as a nursing academic I have primarily been located within three areas of health which have directly impacted upon my current research. I was first positioned within health by undertaking my General Nurse Certificate through hospital-based training commenced in the late 1980s. For me this training meant being immersed within whiteness and specifically the white medical model. This meant learning a set of skills in a large institutionalised health care service with the provision of doctors, nurses, and allied medical staff through a hospital. Within this training there was no Indigenous health curriculum. The lectures provided on 'differing cultures' and health were on Muslim and Hindu beliefs about death. At that point I was painfully aware of the glaring omission of any representation of Indigenous health and of acknowledgment of the current outstanding health differentials between Indigenous and non-Indigenous Australians. I knew that the colonisation process inflicted upon Indigenous Australians was one of devastation. The decline in our health status at the time of colonisation had been felt immediately. Since this time our health has been in decline. While in the 1980s it was now no longer acceptable to shoot us, poison our waterholes, and incarcerate us on missions, we were still experiencing the influence of the colonisation process, which had strong repercussions for our current health status. Our communities were and remain rife with substance abuse, violence, unemployment, and much more. For Indigenous Australians these factors cannot be separated from our initial experience of the colonisation process but are seen as the continuation of it. However, there was no representation of this and I received my first health qualification.Thesis (Masters)
Master of Philosophy (MPhil)
School of Arts, Media and Culture
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Dzidowska, Monika. "A Cluster Randomised Trial to Support Screening and Treatment for Unhealthy Alcohol Use in Aboriginal Community Controlled Health Services." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/29409.
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Background: Evidence-based management of unhealthy alcohol use in primary care has been advocated since 1979. Few studies focus on improving implementation of alcohol screening and treatment in Indigenous primary care, despite greater harms from alcohol in that population group.
Aims: To examine: (i) approaches used to improve screening and treatment for unhealthy alcohol use in primary care internationally; (ii) the effects of the 24-months’ support offered to 22 Aboriginal Community Controlled Health Services on screening and treatment for unhealthy alcohol use.
Methods: Study 1 (systematic review) describes strategies to improve alcohol screening and treatment in primary care and investigates if they employed elements of continuous quality improvement.
Studies 2 and 3 test the effect of the 24-month support on: (i) rates of screening and any alcohol treatment provision; (ii) recommended frequency of screening.
Results: Study 1 found that few implementation strategies focussed on screening and treatments for the full spectrum of unhealthy alcohol use. About 20% of the studies employed the essential elements of continuous quality improvement.
Study 2 showed significant improvement in the odds of screening. The effect on provision of any treatment as well as on individual treatment types was not clear and varied greatly between participating services.
Study 3 was not able to show significant increases in the odds of first-time or annual screening. There were 841 (2%) clients who were screened four or more times annually.
Conclusion: Support provided to Aboriginal Community Controlled Health Services over 24 months can improve the rates of alcohol screening. More focus is needed on screening frequency for individual clients. Further support for the delivery and accurate recording of alcohol treatment is needed. The thesis discusses practice, policy, and research recommendations for future directions in improving screening and treatment for unhealthy alcohol use.
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Fellner, Karlee Dawn. "Returning to our medicines : decolonizing and indigenizing mental health services to better serve Indigenous communities in urban spaces." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/57562.
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While mental health services continue to make efforts toward greater cultural sensitivity, research, education, and practice in these fields remain grounded primarily in Western Eurosettler principles that have been applied in colonization. Addressing the dearth of culturally relevant and appropriate research in Indigenous mental health, the current project applied isîhcikêwin – the author’s Indigenist nehiyaw-otipemisiwak (Cree/Métis) research paradigm to address the question: How can mental health services (be shaped so as to) better serve Indigenous peoples living in urban spaces? isîhcikêwin is based in the author’s lived experiences as a mobile nehiyaw-otipemisiwak woman who is an oskâpêwis (helper) and participant in traditional ceremonies. This framework draws on Wilson’s (2008) conceptualization of research as ceremony alongside the work of other Indigenous scholars (e.g., Archibald, 2008; Castellano, 2000; Graveline, 2000; Holmes, 2000; Kovach, 2009; Marsden, 2005; Smith, 1999).
Following isîhcikêwin ethics and protocols, the author had conversations with sixteen Indigenous mental health professionals and hosted a talking circle. The author used Indigenous holistic meaning making in coming to understand iyinisiwak (knowledge holders’) perspectives, weaving together the stories of iyinisiwak, her interpretive synthesis of their knowledges, and her own personal narratives. The findings comprise a decolonizing framework that is presented as a braid of sweetgrass consisting of three strands: (a) what isn’t working in mental health service provision, (b) restor(y)ing approaches to wellness as ways forward in Indigenous health service provision, and (c) how services can make these transformations. Findings address how approaches to Indigenous wellness in urban spaces may be transformed through the adaptation and application of a medicine bundle framework that incorporates community-based perspectives on love, good relationships, Indigenous knowledges, living a good life, responsibility, identity and belonging, and land. These findings include critical implications for researchers, educators, theorists, practitioners, policy-makers, and other stakeholders whose work involves an aim to contribute to healing and wellness with Indigenous communities.
Consistent with isîhcikêwin, the current dissertation alternates between a scripted dialogue and a conversational style with the reader. This form of representation honours the voices of the author and iyinisiwak, and contributes to research that is congruent with isîhcikêwin from conception to completion.Education, Faculty of
Educational and Counselling Psychology, and Special Education (ECPS), Department of
Graduate
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Jackson, Pulver Lisa Rae. "An argument on culture safety in health service delivery towards better health outcomes for Aboriginal peoples /." University of Sydney. Public Health and Community Medicine, 2003. http://hdl.handle.net/2123/609.
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The bureaucratic measure of health service, health performance indicators, suggest that we are not effective in our legislative responsibility to deliver suitable health care to some of the populations we are meant to serve. Debate has raged over the years as to the reasons for this, with no credible explanation accepted by those considered stakeholders. One thing is clear though, we have gone from being a culture believing that the needs of the many far outweigh those of the few, to one where we are barely serving the needs of the 'any'. This is most evident in the care delivered to the Aboriginal and Torres Strait Islander people of Australia.
10
Peiris, Priyajit David. "Building better primary care systems for indigenous peoples : a multimethods analysis." Thesis, The University of Sydney, 2010. http://hdl.handle.net/2123/12717.
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Macdonald, Mary Ellen 1969. "Hearing (unheard) voices : aboriginal experiences of mental health policy in Montreal." Thesis, McGill University, 2003. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=84525.
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The focus of this dissertation is the mental health experiences of Aboriginal people in Montreal as they interface with health policy, and lack thereof, for this population.Drawing on anthropological fieldwork from Montreal, Eastern Quebec, and Ontario, this thesis endeavours to unravel the jurisdictional tapestry that Aboriginal clients must negotiate when seeking services in Montreal. Using an ethnographic methodology, this project provides an understanding of the ordering of health services for Aboriginal clients from street-level to policy offices.
This thesis draws on three theoretical areas (theories of illness, aboriginality, and public policy) to explicate four themes that emerge from the data. Analysis moves along a continuum between the illness experience and the macro-social determinants of politics and bureaucracy that impact the health of the individual as well as support and organize systems of care.
Discussion of Theme #1 (evolution of mental health and wellness categories in health theory, policy and practice) and Theme #2 ( the culture concept in health policy) demonstrates that despite the progressive evolution of concepts in health theory and policy, Aboriginal people generally do not find services in Montreal that provide culturally-sensitive, holistic care. Discussion of Theme #3 (barriers to wellness created by jurisdiction) argues that jurisdictional barriers prevent clients' access to even the most basic and rudimentary services and that such barriers can actually disable and increase distress. Discussion of Theme #4 ( Aboriginal-specific services) looks at the pros and cons of creating an Aboriginal-specific health centre in Montreal.
Together, these four themes show that understanding Aboriginal people in Montreal requires contextualizing their embodied experience within the colonial history and institutional racism which characterizes many healthcare interactions, and clarifying the bureaucracy that complicates the search for well-being. Montreal's Aboriginal problematic is located in a system characterized by entrenched bureaucracy, jurisdictional complexity and injustice, these elements mapping onto Aboriginal reality with serious repercussions for individual identity and well-being.
Hearing the voices of Aboriginal people in Montreal as they seek out care for mental health problems requires the resolution of jurisdictional and policy clashes that currently silence their suffering. This thesis endeavours to advance this crucial social agenda.
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Boulton, Amohia Frances. "Provision at the interface : the Māori mental health contracting experience : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Māori Health at Massey University, Turitea Campus, Palmerston North, New Zealand." Massey University. Research Centre for Maori Health and Development, 2005. http://hdl.handle.net/10179/254.
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New Zealand's mental health performance and monitoring framework is a complex and evolving one. Its initial development occurred at a time when it was taken for granted that mainstream understandings of health and mainstream systems of service delivery would not only be appropriate for all New Zealanders, but would also service the needs of all New Zealanders. Latterly however there has been an acknowledgment that a wholly different understanding of health and health care has existed in this country; the worldview understood and shared by tangata whenua. This thesis uses a theoretical framework devised specifically for this research to investigate the experience of Maori mental health providers as they contract to provide mental health services for the Crown; to ascertain whether Maori mental health providers deliver outside of their contracts; and to examine the role multiple accountabilities play in contracting. The theoretical framework, the "Maori research paradigm net" is inclusive of both the kaupapa Maori and Maori centred approaches, moving beyond the traditional dichotomy that frames Maori health research and allowing the researcher the freedom to select and use the best and most appropriate research tools from both traditional social science research practices, and from Maori culture and tikanga, to answer the research question posed. The thesis concludes that Maori mental health providers deliver mental health services at the interface between two philosophical viewpoints or worldviews: that of the Maori community in which they are located and to whom they provide services; and that of the funder, from whom they obtain resources to enable them to deliver services. As a consequence of working at the interface, Maori providers regularly and routinely work outside the scope of their contracts to deliver mental health services which are aligned with those values and norms enshrined in Maori culture. To adequately acknowledge and validate the beneficial extra-contractual provision which occurs as a result of delivering mental health services at the interface, and prevent less desirable provision, a more responsive contracting environment and a performance measurement framework, which integrates both worldviews and which takes account of the multiple accountabilities that Maori providers manage, is required.
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O'Grady, Kerry-Ann. "Pneumonia in Indigenous children in the Northern Territory, Australia, and the effectiveness of pneumococcal conjugate vaccine : 1997 - 2005." Thesis, University of Melbourne, 2008. http://purl.org/au-research/grants/nhmrc/359341.
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Gilroy, John. "The Participation of Aboriginal People with Disability in Disability Services in NSW, Australia." Thesis, The University of Sydney, 2012. http://hdl.handle.net/2123/9104.
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This thesis identified the factors that influence the participation of Aboriginal people in the New South Wales Government Department of Ageing, Disability and Home Care (DADHC) funded disability services, as described from the experiences of non-government disability service providers and paid disability service workers in New South Wales, Australia. Although it is known that the rates of morbidity are much higher among Aboriginal people compared with the non-Aboriginal population, the participation rates of Aboriginal people in disability services are under-representative. Various authors have examined these phenomena from the view point of Aboriginal people who may be interested in using disability services. However, there is limited understanding on the views of non-government and Aboriginal and non-Aboriginal workers of disability services about the factors that influence the participation of Aboriginal people in disability services. This study aimed to help fill this knowledge gap by achieving the following three research objectives: 1. Identify how and when the participation of Aboriginal people in disability services was identified in documented policy. 2. Identify and describe the factors that influence the participation of Aboriginal people in disability services as perceived by Aboriginal and non-Aboriginal employees in two NSW Government Department of Ageing, Disability and Home Care funded disability services. 3. Develop an Explanatory Framework that adequately encapsulates and represents the factors identified in this study as influencing the participation of Aboriginal people in disability services. One Aboriginal community controlled organisation and a generic disability organisation were the sites for investigation. Objective one was achieved through a critical historical analysis of policy documents developed by the governments, one Aboriginal community controlled organisation and one generic disability organisation. A rigorous electronic and manual search of publications spanning three decades from 1981 was undertaken. This analysis demonstrated that the disability services sector’s strategies to accommodate the needs of Aboriginal people with a disability have made a limited impact on the service participation rates and have been hampered by Eurocentric models of disability and research. A conceptual framework is proposed to assist disability researchers and policy analysts working with Aboriginal people with a disability. The conceptual framework brings together the strengths of both the International Classification of Functioning, Disability and Health and the Indigenous Standpoint Theory. The second objective was achieved via a situational analysis of transcripts of interviews, focus groups and field notes that were conducted with Aboriginal and non-Aboriginal paid employees of the same government funded organisations. Twelve factors that influenced the participation of Aboriginal people in disability services were identified from the data. Consistent with objective three, an Explanatory Framework was developed which illustrated the relationships between these factors. This framework demonstrated that the factors that influence the participation of Aboriginal people in disability services are inter-dependent historically, culturally and institutionally. The identified factors and explanatory framework are used to guide recommendations for future research, policy development and service provision in the sector.Cerebral Palsy Alliance
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Kahn, Marc Simon. "The interface between Western mental health care and indigenous healing in South Africa: Xhosa psychiatric nurses' views on traditional healers." Thesis, Rhodes University, 1996. http://hdl.handle.net/10962/d1002508.
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Xhosa psychiatric nurses stand unique at the interface between Western mental health care and indigenous healing in South Africa. They stem from a cultural history that is embedded within traditional health care discourses and yet are trained and work within a Western psychiatric model. In embodying the intersection between these two paradigms, they are faced with the challenge of making sense of such an amalgamation. These nurses' views are thus valuable in reflecting this intersection and illustrating many of the central concerns that surround it. This study explicates the views of these nurses toward traditional healers and their potential role in mental health care in South Africa. In addition, it illuminates some of the cultural dynamics at work amongst these subjects as they struggle to make sense of their unique cultural position. Using a questionnaire-based methodology, the views of Xhosa psychiatric nurses in a psychiatric hospital in the Eastern Cape, toward traditional healers and their role in mental-health care, were examined. The findings reveal that the vast majority of these nurses believe in traditional cosmology, involve themselves in traditional ritual practices and regularly visit traditional healers as patients. In suggesting ways in which indigenous healing and Western mental health care can work together, 75% of the nurses were in favour of a general referral system between the hospital and traditional healers, most (77%) agreed that certain patients would be better off being treated by both the hospital and traditional healers than they would if they were only being treated by the hospital alone, and 85% of the subjects agreed that patients who are already seeing traditional healers should check if psychiatric medication might help them. These findings indicate that these nurses operate across two healing systems which are at this point not conceptually compatible. This results in deep cultural tension for the nurses. In being entangled in the dialectical tension created in this context, the nurses manage the incongruencies in three general ways: a) Most, in one form or another, incorporate beliefs from both systems into an integrative model, b) some assimilate their cultural belief system into the Western mental health paradigm, throwing off their beliefs in traditional healing, and c) others remain ambivalent in the dialectic between traditional and Western health care discourses. Although this may suggest that these nurses reside within a cultural milieu that is somewhat unhealthy, at another level, in managing and containing the incompatibility between the two systems, these nurses ensure a space for on-going and healthy critique of the underlying assumptions involved in this health care malaise.
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Gomes, Silvana Cardoso. "Acessibilidade dos usuários indígenas aos serviços de saúde de Cuiabá-MT." Dissertação apresentada ao Programa de Pós-Graduação do Instituto de Saúde Coletiva, como requisito parcial para a obtenção do título de mestre em Saúde Coletiva, 2013. http://www.repositorio.ufba.br/ri/handle/ri/13135.
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Iniquidades no acesso à saúde entre indígenas tem sido um importante problema na organização dos serviços de saúde no Brasil, e uma preocupação recente da literatura especializada, ainda considerada incipiente quanto à produção de estudos empíricos. O presente estudo teve por objetivo avaliar a acessibilidade dos usuários indígenas do DSEI Cuiabá, aos serviços de saúde de média e alta complexidade do município de Cuiabá, em particular, a partir da CASAI Cuiabá, dispositivo voltado para apoio e melhoria da acessibilidade conforme a PNASPI. Foi realizado estudo de caso único na CASAI Cuiabá com abordagem qualitativa. Os dados foram obtidos por meio da observação das rotinas de trabalho da CASAI Cuiabá, entrevistas semi-estruturadas com profissionais e gestores do DSEI Cuiabá e CASAI Cuiabá, análise documental, bem como análise de dados secundários produzidos pelo SIASI sobre utilização dos serviços de saúde de média e alta complexidade em Cuiabá. Para análise dos dados, foi elaborada uma matriz derivada do modelo teórico lógico de acessibilidade e validada por meio do método Delphi a um grupo de especialistas na temática de saúde indígena. Apesar de avanços trazidos pela CASAI na melhoria da acessibilidade indígena, persistem barreiras sócio-organizacionais, culturais e geográficas no acesso à média e alta complexidade do município estudado. Recomenda-se a formulação de estratégias específicas para melhoria da acessibilidade aos serviços de saúde dos povos indígenas mato-grossenses.
Salvador
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Poa, Nicola. "Molecular Genetics of Type 2 Diabetes in New Zealand Polynesians." Thesis, University of Auckland, 2004. http://hdl.handle.net/2292/692.
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The risk of developing type 2 diabetes is four fold higher in New Zealand(NZ) Polynesians compared to Caucasians. Hence diabetes is more prevalent in Maori (16.5% of the general population) and Pacific Island people (10.1%) compared to NZ Caucasians (9.3%). It is generally accepted that type 2 diabetes has major genetic determinants and heterozygous mutations in a number of genes have previously been identified in some subsets of type 2 diabetes and certain ethnic groups. The high prevalence of diabetes in NZ Polynesians, when compared with NZ Caucasians, after controlling for age, income and body mass index (BMI), suggest that genes may be important in this population. Therefore, the prevalence of allelic variations in the genes encoding amylin and insulin promoter factor-1 (IPF-1), and exon 2 of the hepatocyte nuclear factor-1α (HNF-1α) gene in NZ Polynesians with type 2 diabetes was determined. These genes are known to produce type 2 diabetes in other populations. The genes investigated were screened for mutations by PCR amplification and direct sequencing of promoter regions, exons and adjacent intronic sequences from genomic DNA. DNA was obtained from 146 NZ Polynesians (131 Maori and 15 Pacific Island) with type 2 diabetes and 387 NZ Polynesian non-diabetic control subjects (258 Maori and 129 Pacific Island). Sequences were compared to previously published sequences in the National Centre for Biotechnology Information database. Allelic variations in IPF-1 and exon 2 of the HNF-1α gene were not associated with type 2 diabetes in NZ Polynesians. However, in the amylin gene, two new and one previously described allele was identified in the Maori population including: two alleles in the promoter region (-132G>A and -215T>G), and a missense mutation in exon 3 (QlOR). The -215T>G allele was observed in 5.4% and l% of type 2 diabetic and non-diabetic Maori respectively, and predisposed the carrier to diabetes with a relative risk of 7.23. The -215T>G allele was inherited with a previously described amylin promoter polymorphism(-230A>C) in 3% of Maori with type 2 diabetes, which suggests linkage equilibrium exists between these two alleles. Both Q10R and -132G>A were observed in 0.76% of type 2 diabetic patients and were absent in non-diabetic subjects. Together these allelic variations may account for approximately 7% of type 2 diabetes in Maori. These results suggest that the amylin gene maybe an important candidate marker gene for type 2 diabetes in Maori.
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Wilson, Denise. "Ngā kairaranga oranga = The weavers of health and wellbeing : a grounded theory study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, New Zealand." Massey University, 2004. http://hdl.handle.net/10179/992.
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Ngā Kairaranga Oranga – The Weavers of Health and Wellbeing is a theory about the health and wellbeing of Māori women. Health data about Māori women indicate that their health status is less than that of the non-Māori population despite the right to experience equality in health outcomes. Māori women’s health and wellbeing influences the nature of their health outcomes, varies across their lifetime. ‘What is happening for Māori women, their health and interactions with ‘mainstream’ health services?’ is the question that guided the research with Māori women. A grounded theory informed by a Māori centred approach was developed that utilised Mason Durie’s Māori-centred concepts of mana Māori (control), whakapiki tangata (enablement) and whakatuia (integration), and integrated Glaserian grounded theory to guide the collection and analysis of the data. Twenty-three women who identified as Māori within the Te Arawa rohe, and who were between the ages of 18 and 80 years were formally interviewed as either a group, pairs or individuals, with a further 15 informally interviewed during the process of theoretical sampling. Semi-structured interviews and field notes were used to collect the data, and the processes of constant comparative analysis, theoretical sampling and saturation were used to generate a middle-range substantive Māori centred grounded theory. Three core categories were identified relating to the health and wellbeing of Māori women: (a) Mana Māori, which describes what is important for their health and wellbeing; (b) The Way It Is, which outlines the resigned acceptance they have of their reality and life circumstances, and the barriers and challenges that are encountered; and (c) Engaging with Health Services, which describes what they require from ‘mainstream’ health services to improve the access and use of these services. The basic social psychological process of ‘weaving health and wellbeing’ integrates these core categories. The interpretations Māori women have of health and wellbeing, and health-related actions are explained by the theory generated. This substantive grounded theory provides a model to guide the education and practice of health care providers working within ‘mainstream’ health services.
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Wenn, Janice. "Kaupapa hauora Māori : ngā whakaaro whakahirahira o ngā kaumātua : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Māori Studies at Te Pumanawa Hauora Research Centre for Māori Health and Development, Massey University, Wellington, Aotearoa/New Zealand." Massey University, 2006. http://hdl.handle.net/10179/995.
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There is a requirement for all services within the New Zealand health system to be accredited with an established quality organisation and to demonstrate an ability to provide a measurable quality service to consumers. For Māori these requirements must make sense in Māori terms. This thesis is based on the view that, for Māori, the concept of health is more effectively expressed as hauora - optimal health and wellbeing for Māori. This thesis makes five contributions to Māori health and Māori health research. First, it identifies a responsive approach to engaging kaumātua effectively in the process of qualitative research. Second, it identifies a fundamental underlying conceptual framework – kaupapa hauora Māori as a means of understanding hauora – expressed in terms derived from kaumātua in Taranaki and Kahungunu. Third, it adapts this conceptual framework into an analytical research framework and then applies it to allow kaupapa hauora Māori (described in terms of worldview, values and ethics) to be identified from a range of data. Fourth, it critically analyses popular models of Māori health – Te Whare Tapa Whā, Te Wheke and Ngā Pou Mana. Finally, it proposes and details post-doctoral research that will translate kaupapa hauora Māori into a quality services framework/tool. “Kaupapa Hauora Māori” is a conceptual framework articulated by kaumātua, and has its origins in te ao Māori, from which the aronga or worldview is developed. The aronga is composed of the kaupapa or values and tikanga or ethics that provide kaumātua with the values base of hauora. These components have been identified by kaumātua and not only inform the concept of KHM but also inform the analytical research framework that is applied to the data. The values have been identified as a core set of values comprising whakapapa, wairua, whenua, whānau, tikanga te reo Māori, tinana, and hinengaro, and the associated tikanga is expressed as behaviour or ethics. These, together, influence the perception and understanding individuals have of their world and of hauora.
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Paguay, Ruiz R. Patricio. "Relation between Internal Parasites with Basic Services and the Nutritional Status of Children Five Years of Age in the Indigenous, Black and Mestizo Communities of the Rural Area, Imbabura Province." BYU ScholarsArchive, 2000. https://scholarsarchive.byu.edu/etd/5415.
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Various studies have been done to determine the prevalence of anemia in our country, but these studies don't reflect the true magnitude of this sickness, considered in Ecuador a problem of public health since these investigations correspond to urban sectors and margins and not to rural places where the care is very deficient and in certain cases useless, mainly because of the difficult access and the lack of economic resources of the government institutions. The current work was realized in coordination with the school of Nutrition and Dietetics and with the help of the Benson Agriculture and Food Institute was applied in rural communities of the Indigenous, "Mixed-Race" and African-American of Imbabura taking into account kids under the age of 5 as being a population group in constant risk of suffering specific deficiencies, such as Iron deficiency and its subsequent evolution towards Anemia. In this investigation we are going to find information about the prevalence of Anemia in the before mentioned groups of kids, their relationship with the deficiency of the consumption of Iron, influence of one of the most common sicknesses in these sectors as are Intestinal Parasitism. I am sure that the content will be of enormous interest to those that desire to know and better the critical situation of health and nutrition which unwinds this people, because of the provision of updated and truthful information will permit a better orientation of the different programs and projects that are implemented in these areas.
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Lima, Renato de Oliveira. "GestÃo de resÃduos sÃlidos em aldeias indÃgenas: estudo de caso do distrito sanitÃrio especial IndÃgena CearÃ." Universidade Federal do CearÃ, 2015. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=15525.
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The management of solid waste in Indian villages is a little studied topic, but in
great relevance to society, both with regard to these populations full of
specificities, as with regard to the environment because, although societies
diffuse, increasing their contribution to the generation of waste is increasing. This one
work has as main objective to diagnose the situation of solid waste
home and health services in the villages Central, New and St. Anthony in
MaracanaÃ, Enchanted Lagoon, in Singapore, and Varjota, Tapera, Blender and Mixer II,
Itarema, in Ceara state, proposing reduction of viable techniques of waste generation and
of environmentally sound disposal. To characterize the environment of indigenous health
study, a history was presented from the first protective actions to the health of Indian
to this day, with the Special Secretariat of Indigenous Health - SESA. The methodology
work, visits were made to villages, questionnaires, studies
composition of the waste, interviews with those responsible for managing the prefectures and
statistical analysis of the data obtained. As a result, it was observed that there gathering
for household waste in most villages, but the waste of health services
They are collected correctly. Aquiraz and Maracanaà have landfill and Itarema, dump. THE
main form of waste disposal in the villages are burnt and there is the presence of
disease vectors in most homes. Wastes that might not reverse logistics
They are aimed correctly. The villages have high numbers of homes with
breeding and growing crops. As for environmental education, the concept of
Recycling is further known that the concept of composting. The practice of segregation
waste is not common in the villages. The per capita generation of household waste is among
0.60 and 0.80 kg / inhab. / Day. As conclusions, the municipalities of Maracanaà and have Aquiraz
structure sufficient to meet the villages on the management of waste, but
Itarema must be better analyzed. In the villages educational actions must be performed
environmental, designed to prepare the population for implementing collection programs
selective and composting. The Sanitation Indigenous Agent - AISAN is a professional,
properly trained, can be of great support to solid waste management in the villages
indigenous. Finally, as a recommendation should be made more work with this
same methodology as they are few and the work is to be extended to more villages
CearÃ, and for other villages of Special Indigenous Health Districts - DSEI. THE
DSEI and partnership between municipalities is of great value, for only then, all stages of
management may be performed, ensuring a healthy environment and quality of life
indigenous peoples.A gestÃo de resÃduos sÃlidos em aldeias indÃgenas à um tema pouco estudado, porÃm de grande relevÃncia para a sociedade, tanto no que diz respeito a essas populaÃÃes repletas de especificidades, como no que diz respeito ao meio ambiente, pois, apesar de serem sociedades difusas, cada vez mais sua contribuiÃÃo na geraÃÃo de resÃduos vem aumentando. Este trabalho tem como objetivo principal diagnosticar a situaÃÃo existente dos resÃduos sÃlidos domiciliares e de serviÃos de saÃde nas aldeias Central, Nova e Santo AntÃnio, em MaracanaÃ, Lagoa Encantada, em Aquiraz, e Varjota, Tapera, Batedeira e Batedeira II, na Itarema, no estado do CearÃ, propondo tÃcnicas viÃveis de reduÃÃo da geraÃÃo dos resÃduos e de disposiÃÃo final ambientalmente adequada. Para caracterizar o ambiente da saÃde indÃgena em estudo, foi apresentado um histÃrico desde as primeiras aÃÃes de proteÃÃo à saÃde do Ãndio atà os dias de hoje, com a Secretaria Especial de SaÃde IndÃgena - SESAI. Como metodologia de trabalho, foram realizadas visitas Ãs aldeias, aplicaÃÃo de questionÃrios, estudos de composiÃÃo dos resÃduos, entrevista com os responsÃveis pelo gerenciamento nas prefeituras e anÃlises estatÃsticas dos dados obtidos. Como resultados, foi observado que nÃo existe coleta para os resÃduos domiciliares na maioria das aldeias, porÃm os resÃduos de serviÃos de saÃde sÃo coletados corretamente. Aquiraz e Maracanaà possuem aterro sanitÃrio e Itarema, lixÃo. A principal forma de destinaÃÃo dos resÃduos nas aldeias à a queimada e existe a presenÃa de vetores de doenÃas na maioria das residÃncias. Os resÃduos passÃveis de logÃstica reversa nÃo sÃo destinados de forma correta. As aldeias possuem nÃmeros elevados de residÃncias com criaÃÃo de animais e cultivo de plantaÃÃes. Quanto à educaÃÃo ambiental, o conceito de reciclagem à mais conhecido que o conceito de compostagem. A prÃtica da segregaÃÃo dos resÃduos nÃo à comum nas aldeias. A geraÃÃo per capita de resÃduos domiciliares està entre 0,60 e 0,80 kg/hab./dia. Como conclusÃes, os municÃpios de Maracanaà e Aquiraz possuem estrutura suficiente para atender as aldeias quanto ao gerenciamento dos resÃduos, porÃm Itarema deve ser melhor analisada. Nas aldeias devem ser realizadas aÃÃes de educaÃÃo ambiental, visando à preparaÃÃo da populaÃÃo para implantaÃÃo de programas de coleta seletiva e compostagem. O Agente IndÃgena de Saneamento - AISAN à um profissional que, corretamente capacitado, pode ser de grande apoio à gestÃo de resÃduos sÃlidos nas aldeias indÃgenas. Por fim, como recomendaÃÃo, devem ser realizados mais trabalhos com essa mesma metodologia, pois sÃo poucos e esses trabalhos devem ser ampliados para mais aldeias do CearÃ, como para aldeias de outros Distritos SanitÃrios Especiais IndÃgenas - DSEI. A parceria entre DSEI e prefeituras à de grande valia, pois sà assim, todas as etapas do gerenciamento poderÃo ser executadas, garantindo um ambiente saudÃvel e qualidade de vida Ãs populaÃÃes indÃgenas.
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Edwards, William John Werahiko. "Taupaenui : Maori positive ageing : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Palmerston North, New Zealand." Massey University, 2010. http://hdl.handle.net/10179/1331.
Full textAbstract:
The global phenomenon of population ageing has major ramifications for societies and governments around the world. In New Zealand, efforts to address the impacts of population ageing have centred on the Government’s Positive Ageing Strategy. This is a thesis about positive ageing as viewed through Maori eyes. It has been informed by the memories and aspirations of older Maori who have lived through challenging times but have emerged with qualities that enable them to enjoy older age and to contribute to their own whanau, Te Ao Maori (the Maori world) and Te Ao Whanui (wider society). The thesis is philosophically located at the interface between Western science and matauranga Maori, an Indigenous inquiry paradigm. It is argued that Western science and matauranga Maori are relevant to research in the contemporary context, and reflect the realities of older Maori who live in both Te Ao Maori and Te Ao Whanui. The study used research techniques that draw on Western science (literature review), matauranga Maori (review of 42 Maori proverbs) and both inquiry paradigms simultaneously (qualitative study with 20 older Maori people). The research found that Maori positive ageing can be characterised by a two dimensional concept that incorporates a process dimension and an outcome dimension. The process dimension is consistent with a lifecourse perspective and therefore recognises that ageing is a life-long process where circumstances encountered during life may impact cumulatively and manifest in old age. The outcome dimension can be described in terms of complementary ‘universal’ and Maori specific outcome domains. The universal outcome domains are encapsulated in the New Zealand Positive Ageing Strategy and more recently are expressed in the Positive Ageing Indicators 2007 Report. The Maori-specific outcome domains identified in this Study are: kaitiakitanga – stewardship; whanaungatanga – connectedness; taketuku – transmission; takoha – contribution; takatu – adaptability; and, tino rangatiratanga – selfdetermination. The overarching outcome domain is taupaenui – realised potential.
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Gillies, Annemarie. "Kia taupunga te ngākau Māori : anchoring Māori health workforce potential : a thesis presented for the degree of Doctor of Philosophy, Māori Studies, Massey University, Palmerston North, New Zealand." Massey University, 2006. http://hdl.handle.net/10179/994.
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In New Zealand Māori are under-represented in the workforce across multiple sectors. This thesis explores this incongruity with regard to Māori health. A Māori perspective and philosophical foundation formed the basis of the methodological approach, utilising a case study research design to inform the study. This provided the opportunity to explore Māori health workforce development initiatives and their potential to contribute to improvements and gains in Māori health. It was important that this work take into account social and economic factors and their impact on health, as well as the varying political climates of market oriented reform and a fiscal policy focus, because it has not only challenged Māori health development but also provided opportunities for increased Māori involvement and participation in health and New Zealand society. Therefore the thesis, while focused on health takes cognisance of and, coincides with the capacity and capability building efforts that have been a feature of overall Māori development, progress and advancement. In the context of this thesis Māori health workers are seen as leaders within their whānau, hapū, iwi, and Māori communities. Consequently a potential workforce that is strong and powerful can lead to anticipated gains in Māori health alongside other Māori movements for advancement. The potential cannot be under-estimated. This thesis argues that there are critical success factors, specific determinants, influencing Māori health workforce potential, and that these success factors have wider application. Therefore, as this thesis suggests Māori workforce development, especially in relationship to the health workforce, is dependent on effective Māori leadership, the application of Māori values to workplace practices, levels of resourcing that are compatible with training and development, critical mass, and targeted policies and programmes.
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Pinto, Patricia Rech. "Supervisão na formação profissional de agentes indígenas de saúde no Parque Indígena do Xingu." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-13112008-113243/.
Full textAbstract:
A supervisão de agentes indígenas de saúde possui desafios específicos, entre eles a busca do diálogo entre os saberes tradicionais dos povos indígenas e os saberes do modelo biomédico ocidental. A supervisão é considerada uma atividade do processo de trabalho em saúde, que demonstra a quais finalidades se presta em função da necessidade de seu contexto histórico-social mais amplo e da saúde pública. O objetivo do estudo foi analisar o processo de supervisão dos agentes indígenas de saúde, seus componentes e especificidades. Procedemos a um estudo de caso do serviço de atenção primária na região do Médio e Baixo Xingu, Mato Grosso. Utilizamos a análise de conteúdo para o tratamento de dados secundários e primários: documentos institucionais sobre a formação de recursos humanos e entrevistas com agentes indígenas de saúde, lideranças indígenas, representantes da medicina tradicional e profissionais de saúde de nível universitário. As análises fundamentam-se no referencial teórico do processo de trabalho em saúde, com destaque para a supervisão de trabalhadores da saúde, e na abordagem da antropologia médica e relações interculturais. Apresentamos três grandes núcleos temáticos: os agentes do processo de trabalho em saúde indígena; concepções e práticas da supervisão; finalidades da supervisão e da formação profissional de agentes indígenas de saúde. A interculturalidade manifestou-se como característica que permeia todos os núcleos temáticos.The supervision of indigenous agents of health contained specific challenges, among them, the search for the dialogue between the traditional knowledge of the indigenous nations and the knowledge of the west biomedical model. The supervision on health is considered an activity on the work process. It demonstrates which finalities they will work concerning the necessity of a more broaden social-historical context and for the public health. The purpose of this research was to analyze the process of supervising the indigenous agents of health, its components and specificities. We have performed a case study of a primary service attention in the region of Low and Middle Xingu, Mato Grosso. We have used the analysis of content for the treatment of primary and secondary data: institutional documents about the formation of human resources and interviews with indigenous agents of health, indigenous leaderships, representatives of traditional medicine and graduated professionals of health. The analyses are based on the theoretical process of working on health, particularly for the supervision of health workers, and the approach of the medical anthropology and intercultural relationships. Here we present three major thematic areas: the agents in the working process of health itself, the concepts and practices of supervision; and the finalities of the supervision and the professional improvement of indigenous health workers. The articulation of cultures has proved to be a characteristic which are part of all those thematic areas.
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Crengle, Suzanne Marie. "The management of children's asthma in primary care : Are there ethnic differences in care?" Thesis, University of Auckland, 2008. http://hdl.handle.net/2292/4957.
Full textAbstract:
Whole document restricted until August 2010, see Access Instructions file below for details of how to access the print copy.Abstract Background Asthma is a common problem in New Zealand, and is associated with significant morbidity and costs to children, their families, and wider society. Previously published New Zealand literature suggested that Māori and Pacific children were less likely than NZ European children to receive asthma medications and elements of asthma education, had poorer knowledge of asthma, and experienced greater morbidity and hospitalisations. However, none of the previous literature had been specifically designed to assess the nature of asthma care in the community, or to specifically answer whether there were ethnic disparities in care. A systematic review of studies published in the international literature that compared asthma management among different ethnic groups drawn from community-based samples was undertaken. The results of this review suggested that minority ethnic group children were less likely to receive elements of asthma medication use, asthma education and self-management (action) plans. Objectives The primary objectives of the study were to: • describe the use of medications, medication delivery systems, asthma education, and self-management plans in primary care for Māori, Pacific, and Other ethnic group children • ascertain whether there were any ethnic disparities in the use of medications, medication delivery systems, asthma education, and self-management plans in primary care after controlling for differences in socio-economic position and other potential confounders. Secondary objectives were to: • describe the asthma-related utilisation of GP, after hours medical care, emergency departments, and hospital admissions among Māori, Pacific, and Other ethnic group children with asthma • ascertain whether differences in medication use, the provision of asthma education, and the provision of self-management plans explained ethnic differences in health service utilisation. Methods A cross-sectional survey was conducted in Auckland, New Zealand. The caregivers of 647 children who were aged 2–14 years, had a diagnosis of asthma or experienced ‘wheeze or whistling in the chest’, and had experienced symptoms in the previous 12 months were identified using random residential address start points and door knocking. Ethnically stratified sampling ratios were used to ensure that approximately equal numbers of children of Māori, Pacific and Other ethnicity were enrolled into the study. A face-to-face interview was conducted with the caregivers of these children. Data was collected about: socio-demographic factors; asthma morbidity; asthma medications and delivery devices; exposure to, and experiences of, asthma education and asthma action plans; and asthma-related health services utilisation. Results In this study, the caregivers of 647 eligible children were invited to participate and 583 completed the interview, giving an overall completion rate of 90.1%. There were no ethnic differences in completion rates. The overall use of inhaled corticosteroid medications had increased since previous New Zealand research was published. Multivariable modelling that adjusted for potential confounders did not identify ethnic differences in the use of inhaled corticosteroids or oral steroids. Some findings about medication delivery mechanisms indicated that care was not consistent with guidelines. About 15% of participants reported they had not received asthma education from a primary care health professional. After adjusting for potential confounders there were no ethnic differences in the likelihood of having received asthma education from a health professional. Among those participants who had received education from a primary care health professional, significantly fewer Māori and Pacific caregivers reported receiving education about asthma triggers, pathophysiology and action plans. Lower proportions of Pacific (77.7%; 95% confidence interval (95%CI) 70.3, 85.1) and Māori (79.8%; 95% CI 73.6, 85.9) caregivers were given information about asthma triggers compared to Other caregivers (89.2%; 95% CI 84.9, 93.6; p=0.01). Fewer Māori (63.6%; 95% CI 55.7, 71.4) and Pacific (68.1%; 95% CI 60.1, 76.1) caregivers reported receiving information about pathophysiology (Other 75.9%; 95% CI 69.5, 82.3; p=0.05). Information about asthma action plans had been given to 22.7% (95% CI 15.5, 29.9) of Pacific and 32.9% (95% CI 25.3, 40.6) of Māori compared to Other participants (36.5%; 95% CI 28.6, 44.3; p=0.04). In addition, fewer Māori (64.2%; 95% CI 56.1, 72.3) and Pacific (68.5%; 95% CI 60.1, 77.0) reported that the information they received was clear and easy to understand (Other 77.9%; 95% CI 71.8, 84.1; p=0.03). About half of those who had received education from a health professional reported receiving further education and, after adjustment for potential confounders, Pacific caregivers were less likely to have been given further education (odds ratio 0.57; 95% confidence interval 0.33, 0.96). A minority of participants (35.3%) had heard about action plans and, after adjustment for potential confounders, Pacific caregivers were less likely to have heard about these plans (odds ratio 0.54; 95% confidence interval 0.33, 0.96). About 10% of the sample was considered to have a current action plan. The mean number of visits to a GP for acute and routine asthma care (excluding after-hours doctors and medical services) in the previous twelve months were significantly higher for Pacific (3.89; CI 3.28, 4.60) and Māori (3.56; CI 3.03, 4.16) children than Other ethnic group children (2.47; CI 2.11, 2.85; p<0.0001). Multivariable modelling of health service utilization outcomes (‘number of GP visits for acute and routine asthma care in the previous twelve months’, ‘high use of hospital emergency departments’, and ‘hospital admissions’) showed that adjustment for potential confounding and asthma management variables reduced, but did not fully explain, ethnic differences in these outcomes. Māori children experienced 22% more GP visits and Pacific children 28% more visits than Other children (p=0.05). Other variables that were significantly associated with a higher number of GP visits were: regular source of care they always used (regression coefficient (RC) 0.24; p<0.01); lower household income (RC 0.31; p=0.004) and having a current action plan (RC 0.38; p=0.006). Increasing age (RC -0.04; p=0.003), a lay source of asthma education (RC -0.41; p=0.001), and higher scores on asthma management scenario (RC -0.03; p=0.05) were all associated with a lower number of GP visits. Pacific (odds ratio (OR) 6.93; 95% CI 2.40, 19.98) and Māori (OR 2.60; 95% CI 0.87, 8.32) children were more likely to have used an emergency department for asthma care in the previous twelve months (p=0.0007). Other variables that had a significant effect on the use of EDs in the multivariable model were: not speaking English in the home (OR 3.72; 95% CI 1.52, 9.09; p=0.004), male sex (OR 2.43; 95% CI 1.15, 5.15; p=0.02), and having a current action plan (OR 7.85; 95% CI 3.49, 17.66; p<0.0001). Increasing age was associated with a reduced likelihood of using EDs (OR 0.90; 95% CI 0.81, 1.00; p=0.05). Hospitalisations were more likely in the Pacific (OR 8.94; 95% CI 2.25, 35.62) and Māori (OR 5.40; 95% CI 1.28, 23.06) ethnic groups (p=0.007). Four other variables had a significant effect on hospital admissions in the multivariable model. Participants who had a low income (OR 3.70; 95% CI 1.49, 9.18; p=0.005), and those who had a current action plan (OR 8.39; 95% CI 3.85, 18.30; p<0.0001) were more likely to have been admitted to hospital in the previous 12 months. Increasing age (OR 0.88; 95% CI 0.80, 0.98; p=0.02) and parental history of asthma (OR 0.39; 95% CI 0.18, 0.85; p=0.02) were associated with reduced likelihood of admission. Conclusions The study is a robust example of cross-sectional design and has high internal validity. The study population is representative of the population of children with asthma in the community. The three ethnic groups are also considered to be representative of those ethnic groups in the community. The study, therefore, has good representativeness and the findings of the study can be generalised to the wider population of children with asthma in the Auckland region. The results suggested that some aspects of pharmacological management were more consistent with guideline recommendations than in the past. However, given the higher burden of disease experienced by Māori and Pacific children, the lack of observed ethnic differences in the use of preventative medications may reflect under treatment relative to need. There are important ethnic differences in the provision of asthma education and action plans. Future approaches to improving care should focus on interventions to assist health professionals to implement guideline recommendations and to monitor ethnic disparities in their practice. Asthma education that is comprehensive, structured and delivered in ways that are effective for the people concerned is needed.
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Mazars, Nadège. "Les ruses de la pratique subalterne. La santé gérée par les autochtones en Colombie, un multiculturalisme de domination et/ou d'autonomie ?" Thesis, Paris 3, 2013. http://www.theses.fr/2013PA030019.
Full textAbstract:
En 1993, la Colombie réforme son système de santé en suivant les orientations données par la Constitution politique adoptée en 1991 et les recommandations du « consensus de Washington ». Le pays entre dans une nouvelle ère politique dans laquelle la question sociale est redéfinie autour du thème de la pauvreté, tandis que la question ethnique acquière une visibilité inédite. Dans ce contexte, des Entités Promotrices de Santé Indigènes (EPSI) sont créées à partir du modèle générique des EPS, ces organismes d’administration de l’affiliation et des budgets de la santé qui jouent un rôle d’intermédiaire entre l’État et le patient. Les EPSI sont étroitement liées au monde autochtone. Elles gèrent l’accès à la santé d’une population dont la plus grande majorité doit être autochtone. Le personnel qui assure leur fonctionnement est recruté dans l’espace social et politique autochtone. Enfin, ce sont les autorités dites « traditionnelles » qui les contrôlent. Pour être des représentantes des communautés, ces autorités donnent aux EPSI une nature juridique publique, ce qui leur confère un caractère spécifique dans un système de santé où la tendance est à la généralisation de la privatisation. Quelles sont alors les conséquences de l’intégration à la gestion des affaires publiques de ces structures de pouvoir autochtones et de leurs agents. Quels sont aussi les effets de domination et/ou les expressions d’autonomie que la pratique concrète de ce multiculturalisme génère ? Analysant les enjeux qui se dessinent au sein du champ de la santé interculturelle, la thèse s’organise autour de trois moments. Il s’agit d’abord de caractériser le paradigme dans lequel sont pensés, depuis l’État, le système de santé et l’interculturalité pour comprendre comment les politiques du multiculturalisme deviennent un outil de domination par l’intégration. Le mode opératoire de cette gouvernementalité néolibérale s’appuie en particulier sur la promotion de l’empowerment, la participation autochtone au système de santé en étant l’une des expressions. On s’intéresse ensuite à la dimension dialectique des politiques du multiculturalisme à partir d’une enquête ethnographique menée sur trois EPSI dans trois départements (Cauca, César, La Guajira). La pratique de ce multiculturalisme conduit à une réinterprétation du sens qui lui est donné, en particulier au travers de la réappropriation de pouvoirs (contrôle territorial, biopouvoir) par laquelle devient possible la construction d’une autonomie de ces espaces autochtones. Mais cette autonomie n’est rendue possible, et cela constitue le troisième moment de la démonstration, que par l’existence préalable d’une dynamique sociale, collective et historiquement fixée qui a permis la formation d’un groupe d’agents capables de produire un discours et une pratique propre. Il s’agit alors d’étudier au travers de récits biographiques la formation sociale de ces possibles contre-publics autochtones en s’intéressant à la construction des habitus des agents et aux économies morales locales et globales qui ont contribué à la consolidation de ces contre-publicsIn 1993, Colombia reformed its healthcare system by following the orientations brought out by the political Constitution adopted in 1991 and the prescriptions emanating from the « Washington consensus ». The country enters a new political era in which social issues are redefined around the theme of poverty, whereas ethnic issues acquire a new visibility. In this context, Entities Promoting Indigenous Health (EPIH) are created from the generic model of EPHs, which are public administrative bodies dealing with healthcare affiliations and budgets and play an intermediary role between the State and the patient. The EPIH is closely intertwined with the native world. In fact, these entities manage the access to health care services for a population that must be of great majority native. The personnel and agents that run these entities are recruited in the native social and political realm. Furthermore, what is known as the "traditional" authority fully supervises these entities. To officially represent these native communities, these authorities give to the EPSI a public legal status, which confers them a distinctive character in the health care system more generally undergoing privatization reforms. What are the consequences of bringing in indigenous authorities and agents of these health agencies in the administration of public affairs? What are the effect on power relations and/or expressions of autonomy generated by the concrete application of this multiculturalism? Analyzing the issues that are brought out in the realm of intercultural health, this thesis is structured around three main parts. The first part will define the paradigm in which are thought out, from a state perspective, the interculturality of the health care system to understand how politics of multiculturalism, through integration, become a method of domination. The modus operandi of neo-liberal governance is based on the notion of empowerment, i.e. indigenous participation to the health care system being one of its manifestations. The second part will study the dialectical dimension of multiculturalism politics based on an ethnographic study conducted in three EPIH in three states (Cauca, César, La Guajira). The concrete application of this politics of multiculturalism leads to a re-interpretation of its meaning and an re-appropriation of social power dynamnics (territorial control, biopolitics) through which become possible the construction of autonomous indigenous space. However, the third part will analyze how this autonomy is only made possible by preexisting social, collective, and historical dynamics, which enabled a group of agents to produce a discourse and their own application of public affairs. We will thus study with the help of biographical narratives how it is possible to form counterpublics by looking at the habitus of the agents and at the local and global moral economy that helped shape these counterpublics
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Mercier, Amanda. "Trauma-Informed Research and Planning: Understanding Government and Urban Native Community Partnerships to Addressing Substance-Exposed Pregnancies in Portland, OR." PDXScholar, 2014. https://pdxscholar.library.pdx.edu/open_access_etds/1803.
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In 2011, representatives from the Multnomah County Health Departments and several Native-serving organizations came together to address substance-exposed pregnancies among urban Native Americans in Portland, Oregon. From these partnerships, the Future Generations Collaborative was formed representing a significant shift toward community-led maternal child health research and planning. Additionally, the Future Generations Collaborative adopted a historical trauma-informed community based participatory research and planning process. This is particularly significant considering government agencies' role in colonization within Native communities. The purpose of this case study is to explore partnerships between government agencies and the Portland Native community within the Future Generations Collaborative. Given the profound influence of historical trauma in Native communities, this paper addresses how the partnerships between government agencies and the Portland Native community pose distinct opportunities, challenges, and implications.
Drawing from FGC members' lived experiences and an interdisciplinary body of research, I develop a theoretical model for explaining the government's role in creating and sustaining historical trauma within Native communities. This analysis provides critical context for examining the impact of historical trauma on the relationships between government agencies and the Portland Native community within the FGC. By entering methodological discussions of Native-specific community-based participatory research, this study also addresses how the use of a trauma-informed research and planning model affects the relationships between government agencies and the Portland Native community within the FGC.
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McPhail-Bell, Karen. ""We don't tell people what to do": An ethnography of health promotion with Indigenous Australians in South East Queensland." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/91587/1/Karen%20McPhail-Bell%20Thesis.pdf.
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This thesis contributes to the decolonisation of health promotion by examining Indigenous-led health promotion practice in an urban setting. Using critical ethnography, the study revealed dialogical, identity-based approaches that centred relationship, community control and choice. Based on the findings, the thesis proposes four interrelated principles for decolonising health promotion and argues that Indigenous-led health promotion presents a way to bridge the rhetoric and practice of empowerment in Australian mainstream health promotion practice.
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Garay, Jasper. "Social and Emotional Wellbeing service experiences of Aboriginal young people in New South Wales, Australia: listening to voices, respecting experiences, improving outcomes." Thesis, University of Sydney, 2021. https://hdl.handle.net/2123/24528.
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Many Aboriginal and Torres Strait Islander young people in New South Wales have lived experiences of mental health/social and emotional wellbeing services and systems. These lived experiences and knowledges are of great value to services and systems that are seeking to improve mental health/social and emotional wellbeing health outcomes through systemic reform. The lived experiences of Aboriginal and Torres Strait Islander young people are crucial to developing an authentic understanding of why some services and systems work and why some services and systems do not work; they also offer a consumer perspective on how mental health/social and emotional wellbeing services and systems could be improved.
While there is a growing body of research providing evidence suggesting that young Aboriginal and Torres Strait Islander peoples experience very high burdens of mental health/social and emotional wellbeing challenges, there is minimal research on mental health/social and emotional wellbeing help-seeking, service experiences or on what works (and why or why not). This research fills part of that knowledge gap.
This research forms part of a larger body of work being undertaken by the Study of Environment on Aboriginal Resilience and Child Health (SEARCH) team in partnership with several Aboriginal Community Controlled Health Services (ACCHS) in New South Wales, Australia. It aims to privilege the voices, experiences, and perspectives of Aboriginal and Torres Strait Islander young people who use mental health/social and emotional wellbeing services and systems in New South Wales. Through this data the research aims to establish a consumer perspective on how current mental health/social and emotional wellbeing services and systems can build upon current strengths and successes. It also aims to preview
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suggestions for change by positioning the voices of Aboriginal and Torres Strait Islander young people as experts on their own needs.
Aboriginal young people involved in this study did have suggestions for reforms to Social and Emotional Wellbeing services that would improve outcomes across five key themes: access, cultural appropriateness, early intervention, service integration, and effectiveness. Overall, enhanced accessibility to holistic Social and Emotional Wellbeing services that genuinely support clients in their wellbeing journeys was identified as needed. Earlier intervention services were identified as important and requiring further embedment in communities, with services that do exist suggested to better utilise culturally informed and person-centered approaches to care.
This thesis presents a synthesis of related literature, mental health/social and emotional wellbeing data and policies and uses qualitative health research methods to position the voices, experiences, and perspectives of current Aboriginal and Torres Strait Islander young people as experts in this research
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Palheta, Rosiane Pinheiro. "Participação e política indigenista de saúde: o protagonismo indígena em Manaus-AM/1999-2013." Pontifícia Universidade Católica de São Paulo, 2013. https://tede2.pucsp.br/handle/handle/17658.
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Previous issue date: 2013-10-22This survey has as study object indigenous participation in the District Council of Indigenous Health (CONDISI) in the context the Special Secretary for Indigenous Health from Manaus in Amazonas (SESA). It was Set up as the main objective to analyzing the indigenous participation in indigenous health policy focusing on the role of indigenous leaderships in DSEI Manaus / Am Between 1999-2013. The presumption of the thesis is that the indigenous movementin corporate the strategies of the national society to claim those rights to its self-determination with achievements and limitations in the context of indigenous policies such as health. The main references that formented the analys is were found in Brazilian and foreign authors in the Social Sciences area, especially anthropology, health and social work. The adopted methodology involved the bibliographical, documentary and field research with the use of observation and semi-structured interviews with 6 indigenous leaderships from CONDISI and health manager of the Municipal Health (Semsa) in 2012 and 2013. The survey pointed out as the main out come conceptions and conflicting practices of health and participation among health policy and indigenous health characterizing the role of indigenous leaderships in CONDISI to a constant struggle for indigenous self-determination
A pesquisa trata da participação indígena no Conselho Distrital de Saúde Indígena (CONDISI) no âmbito da Secretaria Especial de Saúde indígena de Manaus (SESAI). O objetivo é analisar como a participação indígena vem sendo incorporada nas políticas locais de saúde e qual o papel das lideranças indigenas na construção da política do DSEI Manaus no período de 1999-2013. O objeto central da pesquisa é a análise da participação indígena no âmbito da política de saúde indigenista de Manaus, sobretudo a executada pela SESAI. O principal pressuposto da tese é a de que o movimento indígena tem incorporado estratégias da sociedade nacional para reivindicação de direitos referidos a sua autodeterminação com conquistas efetivas no âmbito das políticas indigenistas como as de saúde. A metodologia adotada englobou a pesquisa bibliográfica, a pesquisa documental e a pesquisa de campo com a utilização da observação e da entrevista semi-estruturada. A pesquisa de campo realizou-se entre os anos de 2011 e 2013 junto ao Conselho Distrital de Saúde Indígena. Dentre os resultados da análise de dados constata-se que a participação enquanto categoria analítica e ao mesmo tempo categoria empírica foi objeto central da pesquisa. Dessa forma foi necessário refazer o trajeto que a participação trilho na historia da construção democrática brasileira. Todavia, apesar dos aspectos comuns que estão no invólucro da participação no seio das políticas públicas o trabalho permite concluir que a participação sob a lente indígena no bojo da política de saude indigenista está aquém das inspirações indigenas e longe do cerne que vem caracterizando a luta do movimento indigena no país. Conclui-se que incorporar as reivindicações indigenas às inovações e mudanças operadas no bojo das políticas de saúde não tem significado melhorias para a qualidade do atendimento e para mudanças efetivas no cotidiano da vida das populações indigenas
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Novo, Marina Pereira. "Os agentes indígenas de saúde do Alto Xingu." Universidade Federal de São Carlos, 2008. https://repositorio.ufscar.br/handle/ufscar/190.
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Previous issue date: 2008-08-12Universidade Federal de Minas Gerais
In the context of restructuring the indigenous health policies over the last 20 years in Brazil, and the consequent creation of the Special Sanitary Indigenous Districts since 1999, the Indigenous Health Agents appear as central elements of this new model for indigenous health attention, since they are understood as possible links or translators between the traditional systems and the official biomedicine. Considering this context, my intention was, through the presentation of ethnographic data about the formation process and the performance of the Indigenous Health Agents at the Upper Xingu, to question the role attributed to them, as well as the model of differentiated attention where this role was proposed. Exactly because they occupy a border position between different medicaltherapeutic systems, the agents performances are involved in several ambiguities and conflicts, which result from the imprecise definition of their functions, as well as from the effective existing conditions for their acting in the spaces attributed to them. I intend to show that the Indigenous Health Agents have their role redefined twice: by the non-indigenous professionals who think of them as transmitters of the biomedical knowledge to the attended populations as well as by the indigenous themselves, who see them as sources of goods and services from national society, in the general context of the political appropriation of this role and its acting spaces by the upper-xinguanos and local leaders themselves.
Dentro do contexto da reestruturação das políticas de saúde indígena ao longo dos últimos 20 anos no Brasil, e a conseqüente criação dos Distritos Sanitários Especiais Indígenas/DSEIs a partir de 1999, os Agentes Indígenas de Saúde/AISs aparecem como elementos centrais desse novo modelo de atenção à saúde indígena, na medida em que são entendidos como possíveis elos de ligação ou tradutores entre os sistemas tradicionais e a biomedicina. Tendo em vista este contexto, o objetivo desta dissertação foi, por meio da apresentação de dados etnográficos relativos à formação e à atuação dos AISs no Alto Xingu, problematizar o papel que lhes foi atribuído, bem como o modelo de atenção diferenciada no qual este papel foi proposto. Observa-se que, exatamente pelo fato de ocuparem uma posição de fronteira entre distintos sistemas médico-terapêuticos, a atuação dos AISs está envolta em ambigüidades e conflitos de diversas naturezas, decorrentes quer de certa imprecisão na formulação do seu papel, quer das condições efetivas das suas atuações nos espaços que lhes foram atribuídos. Procura-se mostrar que os Agentes Indígenas de Saúde têm sua atuação duplamente redefinida: tanto pelos profissionais não-indígenas que os pensam como transmissores dos conhecimentos biomédicos às populações atendidas quanto pelos próprios indígenas, que os vêem como fontes de acesso a bens e serviços provenientes da sociedade nacional, no contexto mais geral da apropriação política deste papel e dos seus espaços de atuação pelos próprios alto-xinguanos e lideranças locais.
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Baptista, Valdir. "Registro audiovisual da omissão do estado brasileiro nas políticas públicas de saúde segundo depoimento de lideranças indígenas." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/6/6136/tde-05122016-142523/.
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Método: Trata-se de uma pesquisa qualitativa de cunho documental utilizando o audiovisual como lócus de instalação de depoimentos de lideranças indígenas do Estado do Acre, Brasil. O objetivo é analisar registros de vivências de lideranças indígenas sobre suas condições de vida, como contribuição às políticas públicas do SUS. E apresentar uma proposta interventiva a partir das potencialidades do vídeo documentário. Resultados: A população indígena, por uma série de motivos, certamente é a parcela da população brasileira sobre a qual menos existem dados específicos que permitam o estabelecimento de políticas de saúde pública eficazes. Embora tenham ocorrido avanços significativos no conhecimento das questões indígenas e um crescente empoderamento das lideranças indígenas na luta por seus direitos básicos de cidadania, a situação ainda está aquém do esperado. Temas relevantes abordados: 1. Participação nas instâncias do poder público/ direitos indígenas. 2. Medicina tradicional exterioridade da doença. 3. Dificuldades com o SUS. 4. Cuidados de saúde nas aldeias. 5. Segurança Alimentar e desnutrição. 6. Qualidade da água e saneamento básico. 7. Logística. 8. Cobertura vacinal. 9. Saúde das mulheres indígenas. 10. Ecologia e biodiversidade. 11. Morte de crianças indígenas. Conclusões: 1. A omissão sistemática dos governos em qualificar agentes de saúde indígenas no tocante às intervenções em saúde individual e coletiva e no exercício dos direitos sociais. 2. Falta de empenho do SUS em contratar profissionais com formação especializada para compor as equipes e direções do Sistema de Saúde que atuam nas aldeias e nos postos avançados de saúde no interior do território. 3. Dificuldades de comunicação entre as equipes do SUS e os povos indígenas. Há barreiras de idioma, de cultura e de percepção do processo saúde-doençaMethod: This is a qualitative research that uses the documentary audio-visual like a place of installation register statements of native indigenous leaders of Acre, Brazil. The objective is to analyze records of indigenous leaders from experiences about their living conditions as a contribution to public SUS policies. And present an interventional proposal from the documentary video potentiality. Results: The indigenous population, for a number of reasons, it is certainly the Brazilian population, on which there is less specific data that allow the establishment of effective public health policies. Although there have been significant advances in knowledge of indigenous issues and a growing empowerment of indigenous leaders in the struggle for their basic rights of citizenship, the situation is still below expectations. Relevant topics approached:1. Participation in public authoritys instances / indigenous rights. 2. Traditional medicine - externality of the disease. 3. Difficulties with SUS. 4. Health care in villages. 5. Food security and malnutrition. 6. Water quality and basic sanitation. 7. Logistics. 8. Vaccination coverage. 9. Indigenous women\'s health. 10. Ecology and biodiversity. 11. Death of indigenous children. Conclusions: 1. the systematic omission of governments in qualify indigenous health workers with regard to the individual and collective health interventions and the exercise of social rights. 2. Lack of commitment of the SUS in hiring professionals with specialized training to compose the teams and directions of the Health System that work in the villages and in the outposts of health in the territory. 3. Difficulties in communication between SUS teams and indigenous peoples. There are barriers to language, culture and perception of the health-disease process
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Morrison, Laurie Elena. "Māori Women and Gambling: Every Day is a War Day!" The University of Waikato, 2008. http://hdl.handle.net/10289/2537.
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This study was concerned with the health implications of new forms of gambling such as casinos, pokie machines and internet gambling for Māori women and their families in Auckland and the Bay of Plenty region of Aotearoa (New Zealand). It set out to discover what culturally appropriate services were available and the extent to which Māori women gamblers were utilising them. The literature documenting Māori perceptions of gambling shows that Māori women gamblers and their partner/whānau members and gambling service providers have been little studied previously. These goals translated into the following specific aims: 1) to study how Māori women problem gamblers, their partner or whānau members and key informants perceived gambling, what it meant to them and why they did it; 2) to investigate the consequences of gambling for Māori women, whānau and service providers in dealing with the effects of gambling; 3) to report on how these three groups dealt with the effects of gambling; and 4) to discover what helped to bring about positive changes for the three groups. All of the aims were achieved. A Māori approach (Kaupapa Māori), combined with a naturalistic approach to data collection, was adopted. Qualitative methods are most appropriate to use when working with some Māori, as there is a growing realisation that research with Māori needs to be interactive. A Māori research procedure modelled on the ritual ceremony of encounter (Pōwhiri) provided an appropriate structure for the development and presentation of the research process. The major focus was on the qualitative data obtained from semi-structured interviews in two locations - Rotorua and Auckland. The interviews were conducted with twenty Māori women gamblers, sixteen whānau members including partners and ten interviews with staff involved in services that provided help for problem gamblers. The three interview schedules were based on a number of broad themes and open-ended questions to obtain meaningful descriptive data. The interviews were audio recorded and used to produce transcripts that were then sent back to the participants for feedback. Qualitative data analysis was conducted on the returned documents. The findings from this study revealed major impacts of the women's socio-economic, familial and societal circumstances on gambling behaviour and its effects, which are areas of concern for mental health professionals and researchers. The mythical Māori canoes on which Māori voyaged from their place of origin (Hawaiiki) to Aotearoa, the Waka, provided an appropriate metaphor to present the interrelationship between the pull and push factors toward gambling, and its implications for society. This is illustrated as a spinning waka, Te Waka Hūrihuri. On the other hand, Te Waka Māia (courageous) demonstrates the relationships between the variables that help Māori women gamblers to cope and helpful strategies found to assist them to modify or stop their gambling behaviour. It is recommended that the government limit the proliferation of gaming venues and continue to encourage development of emerging Māori services. Moreover, a coordinated approach is essential, as Māori women gamblers, partners and whānau members need to heal together for positive outcomes for Māori health development in Aotearoa. The main implication of this study is that a wide range of further research into Māori and gambling is required. Recommendations on ways in which the current delivery of services in Rotorua and Auckland could be improved are: That the Ministry of Health purchase services that establish support groups for Māori people with problem gambling and their whānau, and That non-Māori provider services and organisations support the development of emerging Māori services. Heeding the outcome of this research should help improve New Zealand's existing health policy and capacity for Māori women's health development. It should also enrich our understanding of the adaptation patterns of Māori whānau member/s, and thus should have implications, not only for Māori health policies, but also relevance for the wider field of international cross-comparative research on indigenous gambling and mental health issues. Limitations of this study included a small, localised sample that means the findings can only tentatively be generalised to the wider population of Māori women gamblers. Nonetheless, information gained from the study contributes to understanding of the adaptation patterns of Māori women gamblers, their whānau member/s, and those who are trying to help them. It is hoped that the study will make it at least a little less true that every day is a war day for Māori women and their whānau trying to deal with the problem of gambling.
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Senate, University of Arizona Faculty. "Faculty Senate Minutes December 4, 2017." University of Arizona Faculty Senate (Tucson, AZ), 2018. http://hdl.handle.net/10150/626507.
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Vice, President Research Office of the. "Livable Communities." Office of the Vice President Research, The University of British Columbia, 2009. http://hdl.handle.net/2429/9515.
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What makes a community sustainable? Is it the
effective management of local environmental
resources? Or meeting the social, economic and health needs of its population? For the five UBC researchers in the following pages, the answer is unequivocally both. From tackling water scarcity to environmental health and planning, these researchers are individually working to ensure local communities are equipped with the necessary knowledge to remain sustainable for generations to come.
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Marsden, Dawn Marie. "Indigenous wholistic theory for health : enhancing traditional-based indigenous health services in Vancouver." Thesis, 2005. http://hdl.handle.net/2429/17209.
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How traditional healing can be enhanced in cities, has been the subject of discussion between myself and Indigenous Elders, and between many others, for over 15 years. This project was initiated and completed through the recommendations of Indigenous Elders, through prayer and dreaming, and through increasingly specific factors: 1. Two to four hundred years of unequal relations between colonizing and Indigenous peoples, resulting in 2. Significant and persistent inequalities in the health and educational status of Indigenous peoples, leading to 3. Indigenous calls for more culturally appropriate health services, as reflected in the Royal Commission on Aboriginal Peoples (RCAP), instigating 4. Canadian government strategies for implementing the RCAP recommendations, entitled Gathering Strengths, which prompted a 5. Vancouver/Richmond Health Board review of local Aboriginal health and services, entitled Healing Ways, which led to 6. A Strategic Plan to Develop an Aboriginal Healing Centre in Vancouver, in which traditional healing was emphasized This dissertation affirms and extends prior research, including the National Aboriginal Health Organization document "Traditional Medicine in Contemporary Contexts" by asking how the access and provision of traditional-based health services (traditional healing) can be enhanced, by and for Indigenous peoples in a specific location (Greater Vancouver Regional District; Indigenous pop: 77,500), and by designing, implementing and analyzing this research, using Indigenous wholistic theory, storywork, and talking circle methodologies, protocols, and processes of analysis (prayer, dreaming, reflection, dialogue). Collective storywork, confirms and extends prior research, by providing locally-specific and detailed strategies for societal, institutional and community enhancements, including the establishment of a cohesive governance framework, educational campaigns, establishment of integrated health teams, establishment of a traditional-based Indigenous practitioner's council, establishment of liaison positions, and the establishment of traditional-based Indigenous healing centres. In addition, the research process has resulted in an affirmation and extension of: Indigenous wholistic theory, storywork and talking circle methodologies, Indigenous protocols and processes, a model for Indigenous research entitled a Wampum Research Model, a discussion of the inextricability of health and education, a need to prioritize worldview in the non-medical determinants of health, and Graham Hingangaroa and Linda Tuhiwai Smith's criteria for Indigenous theorizing and Indigenous projects.Education, Faculty of
Educational Studies (EDST), Department of
Graduate
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Stewart, Suzanne L. "Indigenous mental health: Canadian Native counsellors' narratives." Thesis, 2007. http://hdl.handle.net/1828/1835.
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A small yet growing body of literature recognizes the importance of a cultural perspective to mental health services for Canadian Indigenous clients. Although the role of culture has not been studied extensively in counselling psychology, a few investigators have attempted a systemic examination of the area. Using a narrative methodology, five Indigenous counsellors described their perceptions, beliefs and experiences regarding mental health and healing from an Indigenous perspective. A narrative analysis of the data employed story maps to yield within and across participant themes. Overall results included the metathemes of community, cultural identity, holistic approach, and interdependence as integral to mental health and healing for Native clients, with an illustration for counselling that contains specific elements for incorporating this conception into practice. The results are used to inform literature on an Indigenous paradigm of mental health, counsellor training programmes aimed at meeting Indigenous health needs, government policy, and to generate further direction for health research into the Indigenous paradigm in Canada and beyond.
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Kent, Alexandra. "Indigenous health equity as a priority in British Columbia's public health system: a pilot case study." Thesis, 2017. https://dspace.library.uvic.ca//handle/1828/8502.
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For her MPH thesis research, Alex Kent conducted secondary analysis of data from the Equity Lens in Public Health (ELPH) research program to explore whether and how Indigenous health equity is prioritized within one regional health authority [HA100] in British Columbia’s public health system. Her thesis addresses the question: How has Indigenous health equity been identified and prioritized within HA100 as reflected in core documents and plans as well as interviews with key decision makers in the health authority? Using the Xpey’ Relational Environments Framework, a theoretical framework designed by Drs. Charlotte Loppie and Jeannine Carriere, Alex identifies and discusses the physical and theoretical settings where Indigenous health equity is and is not manifested in the public health system. Her findings highlight a number of examples of how HA100 has implemented successful strategies aimed at enhancing Indigenous health equity as well as several areas for improvement across the relational environments. Alex concludes that improving Indigenous health equity through human, non-human and symbolic interactions in institution, system and community settings appears to be a current priority for HA100; whereas reconciling historical relationships and creating equitable social, cultural and political conditions that promote optimal health and wellbeing for Indigenous peoples is positioned as a long-term and indirect goal.Graduate
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Lionjanga, Reginah. "The cultural beliefs and practices amongst urban antenatal Botswana women." Thesis, 2014.
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The purpose of this non-experimental descriptive study was to identify the cultural
beliefs and practices surrounding pregnancy. The study aims at collecting data which
will function as baseline information on cultural beliefs and practices surrounding
pregnancy. The study was conducted in the city of Francistown, the second largest to
the capital of Botswana situated in the north-east. A structured interview guide with
both open and close-ended questions was used to collect data from 230 pregnant
women who were 18 years of age and above and who were willing to participate. The
data was processed on computer and a statistical software package known as
Statistical Package for Social Sciences (SPSS) was used. The study revealed that
pregnant women used a combination of care givers which either included a modem
midwife and an elderly woman at church or a modem midwife and a traditional
midwife. This is done in order to follow the traditional and cultural beliefs
surrounding pregnancy and childbirth. The majority (92.2%) of the antenatal women
in this study had primary and secondary education but still follow their cultural
beliefs and practices, thus education does not appear to influence cultural beliefs and
practices. The most common reasons cited for adhering to the beliefs and practices
were that defiance was a taboo punishable by the ancestors. This study has
highlighted the cultural beliefs and practices related to pregnancy. Further in-depth
investigation into the impact of these cultural beliefs and practices is needed as it is
imperative to determine their impact on pregnancy and its outcome. The limitation of
the study was that data was only collected in one city and therefore the results cannot
be generalised to the entire population.
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Gardner, Karen Louise. "Sustaining quality improvement in indigenous primary health care : a sociological analysis." Phd thesis, 2011. http://hdl.handle.net/1885/155965.
Full textAbstract:
Sustaining the delivery of effective chronic disease care is a major imperative for health systems worldwide. As the prevalence of chronic conditions continues to rise, health systems struggle to provide high quality care that meets the standards set out in practice guidelines. Reorientation of primary health care systems to support the delivery of prevention and management over long timeframes is required. Continuous quality improvement programs are increasingly being used to make and monitor progress towards meeting these objectives. They use participatory action methods to stimulate changes to clinical practice and to the systems that support it. Although research has demonstrated that these programs can be effective, little is known about how they are implemented and sustained, the mechanisms that underpin their impacts, or the influence of implementation processes and context on outcomes. There is a need for research approaches that are better informed by theory to help identify mechanisms and explain change processes or lack of them in different settings. This thesis uses a case study design to investigate factors associated with the sustainability of a large scale CQI program in Indigenous primary health care services in Australia. Drawing on sociological approaches, the study develops and applies a complexity perspective to conceptualise sustainability as the dynamic outcome of interactions between elements of programs and the broader health system and stakeholder environments. It brings together concepts from complex adaptive systems and actor network theory to conduct an in-depth examination of the processes through which participants were engaged in CQI, their use of the audit tools and processes and development of strategies to enact and sustain change. The study demonstrates that despite initial enthusiasm and a complex but broadly conducive environment for developing CQI, using the tools and processes was intensive and time consuming and changing practices to support improvement priorities required services to adapt and realign clinical and administrative processes within and between service systems. Processes of change were reflexive, operating in loops and feedbacks that produced results which were not always intended or predictable. Changes in one part of the system inevitably led to impacts in another. Partial engagement among the stakeholders, workforce shortage and turnover, inter{u00AD}professional relations, poorly aligned patient information systems, bureaucracy and competing priorities in the service environment impeded efforts. Services that were better able to address the impediments they faced had: organisational buy-in; supportive clinical and managerial leadership; someone at the health centre level to coordinate and drive CQI; resources to support team involvement and facilitation; internal communication and feedback; and decision making processes that allowed managers to enact change at the service level. The thesis makes recommendations for changes in practice at the local and regional levels, and in policy at the national level, that will be required to support the widespread adoption and sustained practice of CQI. These practical conclusions are founded in an enhanced theoretical repertoire developed by this thesis that furthers an understanding of implementation processes, and of the relationship between context and programme, in order to improve the sustainability of CQI programmes.
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Banda, Evelyn Chitsa. "Stakeholders' perceptions of the changing role of traditional birth attendants in the rural areas of central Wets zone, Malawi: a mixed methods study." Thesis, 2014.
Find full textAbstract:
Introduction: In 2007, the Ministry of Health in Malawi issued a directive banning
traditional birth attendants (TBAs) from delivering mothers and ordered all mothers to
access skilled birth attendants in health facilities (MoH, 2007b). Anecdotal reports
showed that the influx of pregnant mothers to the health facilities resulted in mothers
delivering on make shift beds on the floor and sometimes without the assistance of the
skilled provider. The badly stretched health care system continues to force mothers to
deliver with the assistance of TBAs who have gone underground for fear of being fined.
Purpose of the study: The purpose of this study was to explore stakeholders’
perceptions of the changing role of TBAs in order to obtain a greater breadth of
understanding of the reasons why home births persist in the rural areas of Central West
Zone (CWZ), Malawi.
Methods: The study employed a mixed method concurrent triangulation design in which
24 health facilities in the districts of Ntcheu, Dedza, Lilongwe and Mchinji, in CWZ,
Malawi were included. A non-probability purposive sampling method was used to select
24 health facilities that provide Basic Emergency Obstetric and Neonatal Care
(BEmONC) services in rural areas of CWZ. A randomly selected sample was used to
collect quantitative data from mothers, using an interview schedule. These were
mothers (n=144) who had come to access maternal and neonatal health care but had
previously sought the help of a TBA to deliver. A total of 55 nurse midwives who
worked in the 24 health facilities and who were available and willing to participate
responded to a structured interview schedule. Quantitative data were analyzed using
SPSS version 19. Qualitative data were collected using focus group discussions (FGDs)
with TBAs (n=4 FGDs, with 6-7 respondents in each discussion group) who lived in the
catchment areas of the selected BEmONC sites. Single in- depth interviews were
conducted with TBA trainers (n=10) in the districts and health professionals (n=12) from
the Ministry of Health and Nurses and Midwives Council of Malawi. Data were analyzed
manually.
Findings: The findings showed that the moratorium on TBAs was implemented without
consultation with the relevant stakeholders and as a result, many mothers in rural areas
continued to seek the services of TBAs. Untrained TBAs took advantage of the
opportunity and together with some trained TBAs who were afraid of punishment went
underground to practice. Maternal and neonatal health care in BEmONC facilities were
deficient as the health care system struggled with challenges such as the lack of
adequate and humane accommodation for waiting mothers, critical shortages of staff,
drugs and supplies and negative health care worker attitudes. In addition, long
distances and the lack of empowerment of rural women prevented mothers from
seeking skilled birth attendants. The study concluded that even though the government
had issued a moratorium on TBAs, the health care system is not coping.
Recommendations: It is recommended that having moved away from the TBAs, there
is no need to revert to using them since that would mean perpetuating harmful and
substandard care for mothers. In addition, TBA services would undermine the
government’s efforts to improve skilled birth attendance. However, the system needs to
urgently deal with the challenges that rural mothers encounter in trying to access skilled
birth attendance.
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John, Maria Katherine. "Sovereign Bodies: Urban Indigenous Health and the Politics of Self-determination in Seattle and Sydney, 1950-1980." Thesis, 2017. https://doi.org/10.7916/D84172QH.
Full textAbstract:
This dissertation compares and connects the parallel histories of two indigenous community-controlled health services, the Seattle Indian Health Board (SIHB) and The Aboriginal Medical Service (AMS) of Sydney. These were among the first clinics of their kind to be established and run by and for urban indigenous communities in the U.S. and Australia. Formed in the 1970s within months of each other, I bring their seemingly disconnected histories together to illuminate a larger transnational history about the political ramifications of twentieth-century postwar urbanization (and the associated growth of an indigenous diaspora) on native people’s concepts and practices of political sovereignty. By considering how these clinics provided a key forum for new urban pan-indigenous forms of political and cultural identity—and claims to indigenous rights—to be expressed and recognized, my work makes two significant contributions. First, it reveals the importance of health as an arena of indigenous political action in the twentieth century. Second, it underscores that indigenous sovereignty, as a political project, must be understood as both adaptive and responsive to change.
Drawing on archival research and oral histories conducted over two years across Australia and the United States—including interviews with activists and health workers who were on the front lines of indigenous politics in the 1950s-1970s—I explain why in their pursuit of self-determination, urban pan-indigenous communities steadily turned away from a purely western conception of sovereignty as jurisdiction over land. The health struggles of urban indigenous peoples since the Second World War are a pointed demonstration of how the loss of even limited territorial sovereignty (that is, relocation from reserves and reservations) led to damaging structural invisibility, discrimination, and neglect within the social welfare system. Thus, this dissertation shows how and why the communities in Seattle and Sydney were driven to pursue other forms of practiced, or what I call “deterritorialized”, sovereignty centering on their rights to self-governance through the creation and transformation of various social organizations (in this case health clinics) in line with distinctive cultural perspectives.
This is the first book-length study to take healthcare reform seriously as an arena in which indigenous political actors worked to redefine the reach and the meaning of indigenous sovereignty for communities without recourse to land or nationhood in the assertion of their sovereign rights. Moreover, by bringing a comparative view to this historical inquiry, my work reminds us that trans-Pacific networks of ideas and people formed a shared context for these peoples and histories. I argue that indigenous health activists in the U.S. and Australia became active at precisely the same moment, because each saw their struggle for recognition and self-determination as part of a global challenge to racism during the Civil Rights era. Moreover, these indigenous community-controlled clinics should be recognized as part of broader changes taking place in grassroots health advocacy at the time, as reflected in the contemporaneous community and women’s health movements, and the movement to form People’s Free Clinics by the Black Panthers.
In its consideration of the unique problems of recognition faced by urban pan-indigenous communities, “Sovereign Bodies” also contributes towards an understanding of processes of ‘place-making’ in a period of great mobility following the Second World War. This dissertation argues that the indigenous urban health clinics very quickly came to represent the social production of a new kind of political space: not a tribal homeland or even a mosaic of different homelands, but a generic native space in the city that gave physical form to new ideas of a non-territorial, or ‘deterritorialized’ sovereignty. Moreover, it shows that at work in the efforts of Seattle and Sydney’s urban indigenous health activists, was the idea of a ‘portable’ or ‘mobile’ indigenous status. This was intended, among other things, to allow indigenous people to live in cities—or wherever they choose for that matter—without having to give up their identity, cultural practices, or their legal status as indigenous people and ensuing ability to make special claims on the government. At stake in their health activism, this dissertation argues, was a form of place-making that aimed to make indigenous people at home everywhere within the national spaces of the U.S. and Australia.
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Noble, Natasha. "Health risk factors in Aboriginal community controlled health services: an exploration of prevalence, clustering, screening options and intervention preferences." Thesis, 2017. http://hdl.handle.net/1959.13/1353444.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)Aboriginal and Torres Strait Islander Australians have a substantially lower life expectancy and greater burden of chronic disease than their non-Indigenous Australian counterparts. The current health status of Indigenous Australians can be linked to a history of colonization and dispossession, as well as to past and ongoing racism and discrimination. While acknowledging the need to address such broader social determinants of health, there is also significant potential to improve the health of Aboriginal and Torres Strait Islander Australians through reducing the disproportionate prevalence of key health risk behaviours among this population, such as smoking, poor diet, excess alcohol and physical inactivity. Primary care is an important setting for the delivery of preventive health care, and Aboriginal Community Controlled Health Services (ACCHSs) are well placed to provide primary care for Aboriginal communities. A range of preventive care interventions have shown success in modifying health risk behaviours in non-Indigenous healthcare settings. However, such strategies are not well tested in Aboriginal health. Therefore this thesis aimed to explore the acceptability of strategies including point-of-care screening, and the provision of patient feedback, in the ACCHS setting. The need for primary care to address ‘lifestyles’ or patterns of interrelated health risks is also being increasingly recognized. In order to inform the provision of more holistic preventive care, this thesis also explored the clustering patterns of key health risk behaviours among ACCHS clients. Patient preferences for addressing their health risks, including whether health risks should be addressed individually, sequentially or simultaneously, and the types of support that would be most helpful, were examined. Implications of the results of these studies for the delivery of appropriate and effective primary care for Aboriginal and Torres Strait Islander Australians are discussed. Based on these findings and drawing on the existing literature, a multi-component, community-based intervention aimed at reducing multiple health risk behaviours is also proposed.
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Stewart, Jessica. "Aboriginal and Torres Strait Islander health: identifying opportunities for health gain through primary health care and targeted research." Thesis, 2015. http://hdl.handle.net/1959.13/1310570.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)This doctoral thesis by publication provides new knowledge in two important and related areas in Aboriginal and Torres Strait Islander health. Firstly, the thesis investigates opportunities in primary health care for reducing some of the major contributors to the health disparity between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. It suggests that strategies are needed to better support patients and GPs in accurately identifying patients at risk and also support the need for a continued policy commitment towards these activities. Secondly, where evidence is lacking of effective primary health care interventions, the research aims to inform health and medical research policy to support research that will maximise health improvements for Aboriginal and Torres Strait Islander people. It aims to inform policy-makers, health practitioners, researchers and Aboriginal and Torres Strait Islander communities on opportunities for health gains that are evident in primary health care and through more targeted health and medical research. One of the key findings of this doctoral research is the lack of intervention research being conducted specifically in Aboriginal and Torres Strait Islander health. It identifies the lack of research outputs that can be used to inform clinical practice as well as health policy and programs. The findings offer strategies that may be able to be implemented into policy to address barriers to increasing the amount of high quality intervention research being conducted in Australia. Another key finding is that research funding disproportionally funds descriptive research rather than measurement and intervention research. The findings aim to inform future health and medical research funding allocation in a way that targets specific health topics, types of research, as well as disciplines that may result in health gains more quickly due to their ability to more rapidly translate findings into policy and practice. The implications of the research aim to be practical and achievable. In primary health care, improving screening according to evidence-based guidelines will greatly improve the health of Aboriginal and Torres Strait Islander people. Where the evidence is lacking on effective health care strategies specifically targeting Aboriginal and Torres Strait Islander people, strategic research is needed that will create evidence to address the major causes of the health gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.
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Chirongoma, Sophia. "Navigating indigenous resources that can be utilized in constructing a Karanga theology of health and well-being (Utano) :an exploration of health agency in contemporary Zimbabwe." Thesis, 2013. http://hdl.handle.net/10413/10691.
Full textAbstract:
Health and well-being are the central concerns for most African people. If health and
well-being (utano) is the top priority for most Africans, the general and almost
complete breakdown of the Zimbabwean public health care system in the past decade
(2000-2010) has had far-reaching repercussions on the whole populace. Whereas
African theology and religious studies have expended considerable energy in
addressing the theme of health and well-being, there have been limited attempts at
developing indigenous theologies. This study plugs the gap in the available scholarly
literature by proposing a Karanga theology of health and well-being paying particular
attention to a specific community‘s responses to the health delivery systems in
Zimbabwe. Through an examination of indigenous responses to health and well-being
and critiquing the collapse of the health delivery systems in the period 2000-2010, the
study argues that understanding health agency in contemporary Zimbabwe enables
appreciating the centrality of utano (health and well-being). This study also seeks to
establish the agency of the community in responding to the national health care crisis,
focusing specially on the Karanga community in Murinye district. It explores the
Karanga healthworlds and documents the agency of the Karanga health-seekers and
health-care providers in responding to the health-care crisis. The major focus of the
study is to establish how the Karanga navigate the existing religious and medical
facilities (Modern scientific bio-medicine; Traditional healing and Faith-healing) in
their search for healing by conducting fieldwork research which entailed the use of
interviews and participant observation. The study was also influenced by oral theology
based on the community‘s underlying faith experiences. It also relied upon the life
history approach and narrative theology to establish trends and patterns in the Karanga
medical system. The study concludes by exploring some useful and life-giving
Karanga indigenous resources that can be utilized in constructing a Karanga theology
of health and well-being in contemporary Zimbabwe. A Karanga theology of utano
places emphasis on a liberative motif which is life-giving and life-enhancing. This
includes acknowledging the agency of health-seekers who are actively involved in
their own welfare. It argues that utano is achieved when, on the basis of indigenous
beliefs and Christian beliefs regarding health, individuals and families invest in
refusing to accept ill-health. Information drawn from study participants demonstrated
how they sought the opinions of traditional healers, prophet healers and modern health
practitioners whenever they felt that their condition was compromised. The study
foregrounds the fact that for the Karanga people, issues of health and well-being
cannot be separated from their religious perspectives. There are diverse religious
traditions among the Karanga people and these inform their understanding of utano.
As such, the three health delivery systems should not be viewed as competitors for
clients but more importantly, they should be viewed as complementing each other.Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2013.
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Akter, Shahinoor. "Examining access to health services for women of reproductive age from ethnic communities in Chittagong Hill Tracts (CHT) of Bangladesh." Thesis, 2020. http://hdl.handle.net/1959.13/1421986.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)Background: During the Millennium Development Goal era, Bangladesh significantly improved maternal health outcomes. However, maternal health data on Indigenous women in the Chittagong Hill Tracts (CHT) is not available and limited evidence suggests that maternal health outcomes for these women have not improved in line with their non-Indigenous peers. This thesis investigates maternal health care (MHC) service access, satisfaction, and experiences among Indigenous women in the CHT, Bangladesh. Methods: To undertake this investigation a sequential mixed-methods design, comprising a population-based cross-sectional survey and qualitative interviews, was informed by an integrative literature review of MHC service utilisation among Indigenous women in lower and middle-income countries. Indigenous women aged 15 to 49 years from Chakma, Marma and Tripura communities, within three years of delivery, were invited to participate in the study. Knowledge about, and prevalence of access to, Ante-Natal Care (ANC), facility delivery and Post-Natal Care (PNC) services were estimated. Factors associated with knowledge, access and satisfaction with care were determined using multivariable logistic regression, adjusted for clustering by village. In-depth interviews with 21 Indigenous women, using qualitative description techniques and with eight key informants (Indigenous community leaders and health care providers) using an ethnographic approach were conducted to explore experiences accessing MHC services. Qualitative data were analysed thematically. Findings from these mixed methods were integrated to formulate policy and practice recommendations and future research. Results: From a total of 494 Indigenous women across two sub-districts, 438 participated in the survey (mean age 25 years, 89% response rate). Survey data revealed the estimated prevalence of knowing about ANC, facility delivery and PNC were 69%, 73%, and 16.4% respectively. Independent factors associated with knowing about ANC services, in order of effect size, were higher education, knowledge about nearest facilities, higher household income and older age. Independent factors associated with knowing about facility delivery were knowledge about nearest facilities; higher household income and attending ANC. Women involved in income generating activities had significantly reduced odds of knowing about delivery services. Factors independently associated with knowing about PNC services were delivery at a facility, knowledge of childbirth complications, access to media and Marma ethnicity. Prevalence of access to any MHC, ANC, delivery and PNC service were estimated at 59%, 53%, 33% and 9.8% respectively. Independent factors associated with accessing any MHC service in order of effect size, were knowledge of nearest facilities, knowledge of pregnancy-related complications, education and number of pregnancies. Independent factors associated with accessing ANC services, were knowledge about ANC benefits, place of residence and higher household income. Independent factors associated with accessing facility delivery were attending ANC, access to media, partner’s level of education and place of residence. Factors independently associated with accessing PNC services were knowledge of PNC benefits and older age. Descriptive analyses of survey data revealed that CHT Indigenous women were satisfied overall with interpersonal relationships with healthcare providers and with communication in their native language. Maintenance of personal privacy was the key independent factor associated with satisfaction of ANC services. Qualitative findings revealed that Indigenous women were not satisfied with MHC services because personal privacy at childbirth was not maintained and because of limited access to health professionals and essential resources at facilities. Interview data revealed that CHT Indigenous women lacked knowledge about freely available, low-cost services within their communities and they mostly accessed MHC services for pregnancy-related complications that were unmanageable at home. Abusive and unprofessional behaviour from staff at public facilities, including Indigenous staff, discouraged women from accessing services. Key informants reported that distance and inadequate resources constrained healthcare providers’ opportunities to provide services. They also reported there was little engagement with communities to inform the design of health programs, thus creating culturally unfriendly environments. Discussion: Access to MHC services was lower among Indigenous women from CHT communities than the national average. CHT Indigenous women experienced discrimination by health staff including Indigenous health staff at public facilities. Absence of community-engagement in the health programs gave limited opportunities for Indigenous women to have their voices heard. Not using Indigenous native language may have limited participation and the cross-sectional design did not allow temporal sequence to be determined and is subject to recall bias and social desirability bias. The small sample of qualitative interviews limits transferability of results and may have been subject to participation bias. Conclusion: Lower access to maternal healthcare services among Indigenous CHT women is associated with a lack of knowledge about services and culturally unfriendly environments. Knowledge about nearest health facilities, pregnancy, and childbirth complications and providing culturally appropriate health systems may improve MHC access for Indigenous women. Community engagement and context-specific interventions are needed to improve maternal health outcomes for Indigenous women and their children.
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Moy, Karen. "Physical activity and fitness measures in New Zealand : a study of validation and correlation with cardiovascular risk factors." 2005. http://hdl.handle.net/2292/305.
Full textAbstract:
The primary aim of the study was to validate the short and long form of the recently-created NZ physical activity questionnaires (NZPAQ-SF and NZPAQ-LF, respectively) in a multi-ethnic sample in Auckland. An international physical activity questionnaire (IPAQ-long) was also validated and compared to the NZ instruments. Objective PA measures were used to create a NZ compendium of PA intensities, providing baseline data for culturally-specific PAs. Secondary aims included an examination of the relationship between PA and CRF, and their associations with cross-sectional measures of cardiovascular (CV) risk factors. The study sample consisted of 186 apparently healthy males (n=90) and females (n=96) aged 19-86 yrs, classified as European/Other (n=60), Māori (n=61), and Pacific (n=65). Heart rate monitoring (HRM) with individual calibration was used to objectively measure the duration, frequency, and intensity of at least moderate-intensity PAs performed over 3 consecutive days. Type of PA and the context in which it was performed was simultaneously recorded by participants on daily PA logs. Correlations between HRM and self-reported levels of brisk walking, moderate-intensity, vigorousintensity, were poor for each questionnaire, and correlations were lower for Māori and Pacific ethnic groups than for European/Other. The NZPAQ-SF (r=0.3, p<0.001) and NZPAQ-LF (r=0.3, p<0.001) performed better than the IPAQ-long (r=0.1, p=0.37). The culturally-specific list of PA intensities showed strong correlation (R2=0.68) to an internationally-accepted compendium of PA intensities, and provided baseline energy cost data for 13 PAs performed by Māori and Pacific people in NZ. CRF levels were primarily influenced by gender, ethnicity, obesity, and performing at least 15 min/day of vigorous-intensity PA, and showed stronger associations with fasting blood lipids and glucose, while PA was more strongly related to SBP and DBP. The validated NZPAQs are acceptable for measuring population level PA prevalence in NZ adults, although accuracy is lower for Māori and Pacific people. However, the availability of a culturallyspecific list of PA intensities could potentially increase the accuracy of self-reported PA by Māori and Pacific people. Results from this study highlight the importance of vigorous-intensity PA for CV health, and identifies NZ Pacific people as high risk in terms of PA, obesity, and CRF.
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Schaaf, David. "Cardiovascular disease risk factors in Pacific adolescents: the Auckland high school heart survey." 2005. http://hdl.handle.net/2292/1947.
Full textAbstract:
Cardiovascular disease is the leading cause of mortality in New Zealand. The most current evidence indicates that the burden of cardiovascular disease is greatest among Maori and Pacific peoples and Pacific peoples have the highest mortality rate for cerebrovascular disease [1]. There is substantial scientific evidence that cardiovascular disease has its origin early in life and that a person's risk of cardiovascular disease is determined by the synergistic effect of all the cardiovascular risk factors over time. The Auckland High School Heart Survey (AHHS) is an epidemiological survey designed to determine the prevalence of risk factors for cardiovascular disease in an adolescent high school population in New Zealand. It takes a 'lifecourse' and primary prevention approach to reducing the incidence of cardiovascular disease. The aims of the study were to determine cardiovascular risk factor levels in, and compare the cardiovascular and diabetes risk factor levels between, Pacific and European students and the main Pacific communities (Samoan, Cook Islands, Tongan, and Niuean). The AHHS was a school-based cross-sectional survey of 2,549 adolescent students, across 10 Auckland High Schools. A cluster sampling technique was used to obtain the target of 1000 Pacific participants, to enable Pacific ethnic-specific analysis. The study specifically aimed to determine ethnic-specific differences in lifestyle, intermediate and outcome variables that have been established as cardiovascular risks. Lifestyle variables included: smoking, alcohol consumption, leisure-time physical activity (LTPA), television exposure and sun exposure. The intermediate variables analysed included: body mass index (BMI), waist to hip ratio (WHR), percentage body fat (PBF) and physical work capacity 170 (PWC170). The outcome variables included: total cholesterol (TC), high density lipoprotein cholesterol (HDLC), ratio of total cholesterol to high density lipoprotein cholesterol (TC:HDLC), low density lipoprotein cholesterol (LDLC), triglycerides (TG), fasting blood glucose (FG), urinary micro albumin (UA), systolic and diastolic blood pressure (SBP & DPB). Demographic variables analysed included: sex, age, ethnic group, school, socio-economic status and growth development and maturation. The AHHS study results showed that demographic variables were strongly associated with both intermediate and outcome variables. The findings showed that there were significant ethnic variations between the four main ethnic groups (Pacific, Maori, Asian and European) in risk factors for cardiovascular disease. Pacific participants had the highest BMI and PBF. Pacific participants had the lowest levels of PWC170. With regard to outcome variables, Pacific adolescents had lower levels of TC, HDLC and LDLC compared to Europeans. However, Pacific participants had higher levels of TC:HDLC, FG, TG and DPB. To a lesser degree, lifestyle variables were also associated with other variables. However, the weaker association was likely due to measurement error. The findings of the AHHS study show that ethnic differences present in the adult population are already established among adolescents [2]. Some significant differences were also found between the Pacific ethnic groups (Samoan, Cook Islands, Tongan and Niuean). Among Pacific participants, Cook Islands participants also had the highest level of adjusted mean PWC170. With regard to outcome variables (lipids, fasting glucose and blood pressure), Tongan participants had lower TC, LDLC and TC:HDLC compared to Samoans. However, Tongan participants had significantly higher levels of TG compared to Samoans. For Pacific participants, Cook Islands participants significantly differed from Samoan in smoking, alcohol consumption and PWC170. Cook Islands participants were more likely to have tried smoking for the first time and at an earlier age. They were also more likely to smoke daily and to smoke higher amounts than the other Pacific ethnic groups. Cook Islands participants were more likely to have tried alcohol and at an earlier age. They were also more likely to be drinking alcohol weekly or more often when compared to Samoans. The AHHS study is one of the first pieces of epidemiological research undertaken in New Zealand that provides evidence that there are significant differences between Pacific ethnic groups for this age group. The AHHS study was also able to identify the determinant that explains ethnic differences in outcome variables. BMI was the most significant variable in determining the ethnic differences in outcome variables (lipids, blood pressure and fasting glucose). The AHHS study results showed that Pacific participants had the highest BMI levels of all the ethnic groups, followed by Maori. Television watching was the one lifestyle risk factor that was positively associated with BMI. The most effective variable in terms of decreasing mean difference in BMI was PWC170. PWC170 was significantly lower in Pacific, Asian, and Maori participants compared with European participants. Pacific participants had the lowest levels of PWC170 compared to all other ethnic groups. The AHHS findings support early interventions and programmes targeted to adolescents to reduce the incidence of cardiovascular disease. The findings which show that there are significant differences between Pacific ethnic groups for this age group, may warrant some specific public health initiatives being targeted directly to Pacific ethnic-specific groups. In addition, interventions and programmes that target reducing BMI and improving physical fitness should have an impact on a number of important cardiovascular risk factor outcome variables in adolescents, including: blood pressure, lipids and fasting glucose.
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Kampf, Antje. "'To map out the "venereal wilderness"' : a history of venereal diseases and public health in New Zealand, 1920-1980." 2005. http://hdl.handle.net/2292/2202.
Full textAbstract:
This thesis traces the public health debate about venereal disease in New Zealand from 1920, when the first venereal disease clinics were established, to 1980 before the first AIDS/HIV cases emerged. Studies of venereal disease in New Zealand have concentrated on issues of morality and on the political and social debates; this thesis focuses on treatment procedures and Health Department campaigns. The thesis explores the role of doctors in relation to venereal disease. While advancements in drug therapy benefited patients, medical authority was undermined by demanding and defaulting patients, inadequate medical education, and a low status of the profession. The medical profession developed epidemiological studies and defined 'at risk' groups in post-war decades. Despite claims to be 'scientific', the assessments were informed by stereotypes which had changed little over time. The thesis evaluates the scope of preventative health campaigns. Defined as a public health issue by the 1920s, venereal disease was seen as an individual responsibility by the 1960s. During this time the use of legislation declined, and education and contact tracing increased. The control of infection was limited owing to financial and administrative problems, defaulters and opposition from doctors. Those deemed most at risk were not reached by government educational campaigns, leaving much to the work of welfare groups and individual doctors. The health campaigns targeted groups like Maori and servicemen. The historiography has tended to overlook Maori, and, when military campaigns are discussed, to focus on females. This thesis attempts to redress the balance. Maori had, at least until the 1950s, different treatment experiences from non-Maori patients, although this did not necessarily imply discrimination. The military did attempt to control servicemen, though each Service had different experiences. This thesis stresses the complexity of the gender issue. There was a change from blaming females for infection in the early twentieth century to increasingly pointing to male responsibility. Despite these changes, even with the concept of individual risk pattern by the 1960s, and the understanding that men could be asymptomatic carriers, women were persistently seen as the 'reservoir'. A gender bias persisted.Note: Thesis now published. (2007) Kampf, Antje. Mapping Out the Venereal Wilderness: Public Health and STD in New Zealand, 1920-1980. Berlin: Lit-Verlag. http://www.lit-verlag.de/isbn/3-8258-9765-9. Whole Document not available at the request of the author.
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Stuart, Keriata. "Trading off : a grounded theory on how Māori women negotiate drinking alcohol during pregnancy : a thesis presented in partial fulfilment of the requirements for the degree of Master of Public Health at Massey University, Wellington, New Zealand." 2009. http://hdl.handle.net/10179/1211.
Full textAbstract:
This study aimed to understand how Maori women negotiate decisions about alcohol and pregnancy. It was based in the recognition that Maori women?s decisions about drinking alcohol when pregnant are shaped by social and cultural expectations about gender roles, as well as their knowledge about alcohol and pregnancy. Maori attitudes to alcohol have also been influenced by colonisation and Maori responses to it. Alcohol use in pregnancy also exists in the context of potential impacts, including fetal alcohol spectrum disorder. There is little knowledge about how and why women may or may not drink during pregnancy. The research used grounded theory methods. Information was gathered through in-depth interviews with ten Maori women. The information they provided was analysed using constant comparative analysis, and a series of categories was generated. The grounded theory proposes that Maori women manage decisions about drinking alcohol when pregnant using a process of Trading off. Trading off is supported by three key processes: drawing on resources, rationalising, and taking control of the role. Maori women start by learning the rules about alcohol, get messages about alcohol and pregnancy, change their alcohol use while making role transitions, and use alcohol in the processes of fitting in where you are, releasing the pressure, and carrying on as normal. Trading off is an individual process, but exists in a complex social context. The process is fluid, conditional, and continues throughout pregnancy. The theory must be recognised as my interpretation, although I believe it is grounded in the data, accounts for the data, and offers a new, modifiable and potentially useful interpretation. While the body of theory that can be compared to the theory of Trading off is limited, the interpretation is consistent with several models of health behaviour, including Maori health models. This research has implications for future research, and for the development of programmes to support Maori women.